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Gabapentinoid suggested tapering regimes Pregabalin and gabapentin should only be prescribed where there is evidence of neuropathic changes / neuropathic pain, and even then 50% of patients will not get any benefit at all. Some people can become addicted to gabapentin. If this happens, you’ll have withdrawal symptoms after you stop taking the medicine. When you stop taking gabapentin, you'll need to reduce your dose gradually to avoid withdrawal symptoms. Do not stop taking gabapentin without talking to your doctor. Consult your doctor before you stop taking gabapentin. Never stop taking this medication all at once. Your doctor can help develop a plan to help you taper off. Co-prescribing of opioids and gabapentinoids should be avoided if possible, due to the increased risk of respiratory depression, accidental overdose, and death. The MHRA and manufacturers advise that when prescribing gabapentin in patients who require concomitant treatment with opioid medicines, patients should be carefully observed for signs of CNS depression, such as somnolence, sedation A structured gabapentin taper chart helps ease withdrawal and minimize risks, but knowing what works—and what doesn’t—matters just as much. Learn more. For a person with trigeminal neuralgia, see the CKS topic on Trigeminal neuralgia. For a person with sciatica, see the CKS topic on Sciatica (lumbar radiculopathy). For a person with any other neuropathic pain condition, including painful diabetic neuropathy: Offer a choice of amitriptyline, duloxetine, gabapentin, or pregabalin. Titrate the dosage according to response and tolerability Palliative cancer care - pain: What issues should I consider before prescribing gabapentin? Last revised in April 2025 For prescribing information, see the section on Gabapentin in the CKS topic on Neuropathic pain - drug treatment. The Innovation To address these issues and as part of her work within the CARE programme, Elizabeth conducted a search of people taking either gabapentin or pregabalin to identify why they were being prescribed and the scope of the problem. Two groups were identified for reviews, those aged 60 years and under who were known to have back problems who may be being prescribed gabapentinoids 7 Draft for consultation, October 2021 This guideline covers prescribing and managing withdrawal from opioids, benzodiazepines, gabapentinoids, Z-drugs and antidepressants. The guideline assumes that non-pharmacological treatment options have been discussed and offered where appropriate before these medicines are prescribed. The guideline does not cover use of opioids prescribed for acute pain how difficult it might be to stop the medicine later and how that might be managed (see the section on withdrawing a dependence-forming medicine or antidepressant) that missing doses may lead to symptoms of withdrawal how to store medicines safely (for more information, see the NICE guideline on controlled drugs). Covers the management of menopause, perimenopause, and premature ovarian insufficiency, including lifestyle strategies, non-drug treatments, and/or drug treatment options, and when to refer. Does not cover management of people who have had or are having gender affirming hormone therapy. Information for adults prescribed gabapentin Gabapentin belongs to a group of medicines called anticonvulsants and can also be used to treat epilepsy. Gabapentin is licensed for the treatment of peripheral neuropathic pain such as painful diabetic neuropathy and postherpetic neuralgia in adults [ABPI, 2020a]. However, the National Institute for Health and Care Excellence (NICE) recommends gabapentin as a first-line treatment option for adults with all neuropathic pain (except trigeminal neuralgia) [NICE, 2019a]. How to stop gabapentin safely when used for treating nerve pain Patient Information Leaflet If you have any questions about your medication please ask your doctor, nurse, or pharmacist. • Storage instructions: Please keep all medications in a safe place out of sight and reach from children, pets, and vulnerable adults. If you have severe side effects, stop taking gabapentin straight away and inform your GP as soon as you can. If you have mild side effects but an improvement in your pain, you may wish to continue the medication without increasing the dose. How do I take it? It is important to build up the dose gradually, to help prevent problems. Neuropathic pain is a symptom that develops as a result of damage to, or dysfunction of, the nervous system. 4. Review Throughout NeP management patients should be reviewed regularly to optimise treatment. During these reviews the patient should be asked if the gabapentin/pregabalin prescribed has made a difference to the pain (Neuropathic Pain Scale) If the patient does not experience improved pain relief or if the pain has resolved consider stopping. Current evidence suggests that the risk of • When cross tapering from gabapentin to either duloxetine or pregabalin, the dose of gabapentin should be reduced in accordance with the above table until the patient is taking gabapentin 300 mg daily. For adult patients with persistent pain patients taking strong opioids and/or gabapentinoids Clinical evidence shows limited effectiveness and patient safety concerns due to the risks associated with long-term use of opioids and gabapentinoids.1 Stopping antidepressant treatment the timing of when to stop antidepressant treatment is discussed in menu item below (length of antidepressant treatment) patients should be advised not to stop treatment suddenly or omit doses - patients should also be forewarned about possible symptoms that may occur when treatment is discontinued Drug and Therapeutics Bulletin (1) advises: after a 'standard
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