Tapering off gabapentin and pregabalin
Gabapentin and Lyrica are prescribed for far more conditions than they are approved for, and often at doses nobody has revisited. Coming off needs a plan — abrupt withdrawal can trigger seizures.
What gabapentinoids are, and why they are prescribed
Gabapentin and pregabalin are approved for nerve pain — after shingles, and in diabetes — for certain seizure disorders, and, in pregabalin's case, for fibromyalgia. They are also among the most heavily prescribed off-label medications in the United States, used for back pain, sciatica, general chronic pain, anxiety, alcohol withdrawal and sleep.
That breadth is why so many people are on one without a clear record of why. A dose started during a bad episode of back pain years ago is still being renewed, often alongside other sedating medications.
Pregabalin is a controlled substance in the United States, and both medications carry an FDA warning about serious breathing problems when combined with opioids or other central nervous system depressants. Neither should be stopped abruptly.
Generic and brand names
If you are taking gabapentin or pregabalin to control a seizure disorder, do not reduce it without the involvement of the provider managing that condition. We will coordinate with them rather than work around them.
| Generic name | Common brand names | Typically prescribed for |
|---|---|---|
| Gabapentin | Neurontin, Gralise, Horizant | Nerve pain after shingles, partial seizures, restless legs (Horizant); widely used off-label for other pain, anxiety and sleep |
| Pregabalin | Lyrica, Lyrica CR | Diabetic nerve pain, nerve pain after shingles, fibromyalgia, nerve pain after spinal cord injury, partial seizures |
What long-term use can look like
The effects are dose-related and often creep up, which makes them easy to attribute to age, the underlying condition, or simply a bad year.
The most commonly reported effect, and the one most likely to cause a fall.
Drowsiness, difficulty concentrating and word-finding trouble, with implications for driving and work.
Fluid retention in the ankles and legs, and weight gain that can be substantial over years.
The combination of dizziness, sedation and unsteadiness makes this a class that deprescribing guidance flags for review.
With opioids, benzodiazepines or other sedatives, gabapentinoids increase the risk of serious respiratory depression.
For several of the off-label uses the evidence of benefit is weak. A supervised reduction is often the only way to find out whether the medication is doing anything for you.
What stopping abruptly can feel like
Withdrawal is more pronounced than most people expect, and more so at higher doses and after longer use.
Restlessness, edginess and a sense of dread, often disproportionate to anything happening.
Difficulty falling asleep and staying asleep for the first days to weeks after a reduction.
Sweating, queasiness, stomach upset and a racing heart.
Return or temporary worsening of the pain the medication was treating, which can be mistaken for the condition deteriorating.
Headache, shakiness and muscle twitching.
Reported after abrupt discontinuation, particularly at higher doses or in people with a seizure history. This is why the reduction is stepped rather than stopped.
Before you change anything
This page is general information about a group of medications. It is not medical advice about you, and it is not a reason to change a dose on your own.
Several of the medications Prescriby Health tapers can be dangerous to stop abruptly. If you are in withdrawal now, contact your prescriber or an urgent care service today. If you feel unsafe, call 911. For mental-health crisis support in the US, call or text 988.
How we taper gabapentinoids
In planned percentage steps, spaced to give your nervous system time to adjust, with the steps getting proportionally smaller as the dose comes down. Where you are taking the medication several times a day, the reduction is usually applied one dose at a time rather than across the whole day at once.
Because so many gabapentinoid prescriptions are off-label, part of the work is establishing what the medication is currently doing for you. Sometimes a reduction reveals that it was doing very little; sometimes it shows that a lower dose achieves the same thing. Both are useful answers.
We take over prescribing the medication being reduced for the duration of the taper. You log pain, sleep and symptoms in the Prescriby app between visits, and if a step is too hard we hold it or shrink the next one. If you are also on an opioid or a sedative, we plan the order of the reductions rather than tackling them all at once.
Learn more
Related reading on tapering and on how the program works.
Intake, the taper schedule, follow-up intervals, cost, and who the program is and is not right for.
The six groups we work with, with generic and brand names for each.
Clinical insight, patient stories and company news from Prescriby Health.
Questions about gabapentinoids
Gabapentin and pregabalin cause physical dependence, so stopping suddenly causes withdrawal. Misuse does occur — pregabalin is a controlled substance in the United States for that reason — but most patients we see are simply dependent after years of prescribed use, which is a different problem with a different solution.
Off-label prescribing is legal and often reasonable: a provider judged it worth trying, frequently as an alternative to an opioid. The question worth asking now is not whether starting it was justified, but whether continuing it is — and that is what a review is for.
Typically several weeks to a few months, depending on dose, how long you have taken it, and whether we are reducing anything else at the same time. Higher doses and longer use mean a slower schedule.
It may flare during the reduction, which is expected and usually temporary. If the underlying nerve pain genuinely needs treatment, the plan addresses that rather than leaving you without options. For several off-label uses, patients find the pain is no worse at a lower dose or off the medication entirely.
It changes the plan. Reducing a medication that is currently holding your sleep or anxiety together needs something to take its place, and your provider will talk that through before the first reduction rather than after it.
Ready to talk about gabapentinoids?
Tell us the name on the box and how long you have been taking it. We will tell you what a taper would look like.
You do not need a referral. Providers are welcome to refer directly.