Gabapentinoid reduction

What are gabapentinoids?

Gabapentinoids include gabapentin and pregabalin. They can be used for neuropathic (nerve) pain but are not recommended for other types of pain.

Not everyone will benefit from a gabapentinoid. Some people experience side effects. You should consider the risk and benefit of treatment. The goal is to improve function and quality of life. Gabapentinoids should be stopped gradually if not helping or causes problems.

Should I reduce my gabapentinoid dose?

A review can help to assess your treatment. A trial reduction should be considered every 6-12 months to check;

• Whether nerve pain is still a problem
• If you are getting benefit from the medication
• If you are experiencing any side effects

How to reduce a gabapentinoid

The dose should be reduced gradually. This will minimise any withdrawal effects and check if there is any change in your pain.

The dose can be reduced in reverse order to how it was increased.

For example:

Gabapentin Reduced by 300mg per week.

Pregabalin Reduced by 75mg per week.

Follow your reduction plan agreed with your health care professional. You may require different strengths of medication to complete a reduction.

Avoid reducing at the wrong time

• Avoid reducing your dose during a stressful period.
• Do not reduce your dose during a flare-up.
• Avoid more than one medication change at a time.

What are withdrawal symptoms?

Withdrawal symptoms may occur if you stop taking gabapentinoids suddenly. The most common withdrawal effects are:

• Anxiety
• Difficulty sleeping
• Nausea
• Pain
• Sweating

These symptoms can occur within a day, last up to seven days, or sometimes longer.

If you do get withdrawal effects, then do not reduce further. Maintain the dosage that you have reduced to and wait for the withdrawal effects to settle before reducing further.

You may need to reduce more slowly or by smaller amounts to manage these effects.

What if my pain increases?

If your pain increases, stop reducing your dose and maintain your current dose.

If the increased pain does not settle within a few weeks, speak to your doctor or pharmacist.

Medication in chronic pain

Medicines are not always helpful for long-term pain.

They can cause side effects and harm.

It is best to stop medicines that are not working or cause problems.

It is helpful to find other ways of managing pain.

A doctor or pharmacist can explain more.

Remember

Do not stop medicines suddenly.

Do not share medicines.

Never take more medicine than prescribed.

Let your doctor or pharmacist know if you take other
medicines or products.

Read the information sheet for each medicine.

Keep medicines out of the reach of children.

Store medicines safely.

Return unused medicines to your pharmacy.

If your medication make you drowsy, do not drive.

Discuss any medication concerns with your doctor or pharmacist.

Suggested gabapentin reduction plan for chronic pain

The suggested time period for each stage is seven days

Current total daily dosage 2700mg	Morning	Afternoon	Bedtime
	900mg (3x300mg)	900mg (3x300mg)	900mg (3x300mg)
Reduce by 300mg
Total daily dose 2400mg	900mg (3x300mg)	600mg (2x300mg)	900mg (3x300mg)
Reduce by 300mg
Total daily dose 2100mg	600mg (2x300mg)	600mg (2x300mg)	900mg (3x300mg)
Reduce by 300mg
Total daily dose 1800mg	600mg (2x300mg)	600mg (2x300mg)	600mg (2x300mg)
Reduce by 300mg
Total daily dose 1500mg	600mg (2x300mg)	300mg (1x300mg)	600mg (2x300mg)
Reduce by 300mg
Total daily dose 1200mg	300mg (1x300mg)	300mg (1x300mg)	600mg (2x300mg)
Reduce by 300mg
Total daily dose 900mg	300mg (1x300mg)	300mg (1x300mg)	300mg (1x300mg)
Reduce by 300mg
Total daily dose 600mg	300mg (1x300mg)	Nil	300mg (1x300mg)
Reduce by 300mg
Total daily dose 300mg	Nil	Nil	300mg (1x300mg)
Reduce by 300mg
Total daily dose 0mg	Nil	Nil	Nil

If you do experience withdrawal effects or your pain increases, then see advice above.

Suggested pregabalin reduction plan for chronic pain

The suggested time period for each stage is seven days

Current total daily dosage 600mg	Morning	Evening
	300mg (1x300mg)	300mg (1x300mg)
Reduce by 75mg
Total daily dose 525mg	225mg (1x150mg + 1x75mg)	300mg (1x300mg)
Reduce by 75mg
Total daily dose 450mg	225mg (1x150mg + 1x75mg)	225mg (1x150mg + 1x75mg)
Reduce by 75mg
Total daily dose 375mg	150mg (1x150mg)	225mg (1x150mg + 1x75mg)
Reduce by 75mg
Total daily dose 300mg	150mg (1x150mg)	150mg (1x150mg)
Reduce by 75mg
Total daily dose 225mg	75mg (1x75mg)	150mg (1x150mg)
Reduce by 75mg
Total daily dose 150mg	75mg (1x75mg)	75mg (1x75mg)
Reduce by 75mg
Total daily dose 75mg	0mg (Nil)	75mg (1x75mg)
Reduce by 75mg
Total daily dose 0mg	0mg (Nil)	0mg (Nil)

If you do experience withdrawal effects or your pain increases, then see advice above.

Your plan for gabapentinoid reduction for chronic pain

This can be completed by your doctor or pharmacist

Medication
Current total daily dosage	Morning	Afternoon	Bedtime
Reduce by ………… mg every ………… week(s)
Total daily dose ……….mg
Reduce by ………… mg every ………… week(s)
Total daily dose ……….mg
Reduce by ………… mg every ………… week(s)
Total daily dose ……….mg
Reduce by ………… mg every ………… week(s)
Total daily dose ……….mg
Reduce by ………… mg every ………… week(s)
Total daily dose ……….mg
Reduce by ………… mg every ………… week(s)
Total daily dose ……….mg

Additional Notes: