filly asked
I have been taking 5 capsules of 300mg gabapentin 3 times a day for about 3 to 4 months, for neuropathy. I really want/need to taper off and would appreciate your help on how to do so safely. Thank you!
Answer
Neurontin (gabapentin) is typically recommended to be tapered as opposed to stopping "cold turkey" to avoid withdrawal symptoms, regardless of the indication you are taking it for (e.g. neuropathy, epilepsy etc...). While most withdrawal reactions are relatively mild in severity, abrupt withdrawal of gabapentin has been associated with rebound seizures in those who are treating epilepsy. Below, we discuss why gabapentin should be tapered and recommendations to do so.
Potential Withdrawal Reactions From Gabapentin
Various studies have reported potential withdrawal reactions to include:
- Anxiety
- Insomnia
- Nausea
- Sweating
- Pain
- Irritability
- Agitation
- Akathisia
- Palpitations
- Diarrhea
- Seizures
- Headache
- Fu-like symptoms
- Weakness
- Increased blood pressure
- Symptom recurrence (e.g. pain from neuropathy)
Some sources liken symptoms of gabapentin withdrawal to that of alcohol and benzodiazepine withdrawal, due to a similar mechanism of action. The longer you have been taking gabapentin, the more susceptible you are to experiencing withdrawal effects. Therapy of as little as one month may put you at risk.
When stopping or beginning a downward taper of gabapentin, withdrawal symptoms generally begin within 1 to 2 days (if they occur at all).
How To Taper Gabapentin
There is no single recommendation on how to safely taper gabapentin and the method employed will be determined by you and your doctor. There are many factors to consider including:
- Condition being treated
- How long you have been taking the medication
- What dose you were taking
- Your medical history
The prescribing information does not recommend stopping gabapentin abruptly, but unfortunately does not give direction on an appropriate tapering method:
"Antiepileptic drugs [gabapentin] should not be abruptly discontinued because of the possibility of increasing seizure frequency."
Based on available information regarding gabapentin:
- Most sources recommend to taper gabapentin over at least one week.
- However, those who are treating seizures may need to taper more slowly, over a few weeks to a few months to reduce the risk of withdrawal seizures.
One study recommends to taper gabapentin in a way similar to benzodiazepines medications, meaning over an extended of time at a designated interval. For example, one source recommends to taper your original dose by 10-25% every week, and monitor for any negative symptoms. If they do occur, it may be prudent to slow your taper.
Overall, withdrawal symptoms with gabapentin are thought to be less severe, and happen less frequently, when compared to other classes of medication (e.g. benzodiazepines). Nevertheless, the potential withdrawal symptoms can negatively impact your quality of life, and rarely, be serious (e.g. if you have seizures). Be sure to speak with your doctor regarding the best method to taper gabapentin in your situation.
