What is an effective taper for gabapentin 300 mg tid?I want to take someone off gabapentin since she has history of intentional overdose. did not use gabapentin but since she has ongoing anxiety and depression, i want to safely taper her down.
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- Answered 18 Feb 2020 Conflict of interest declaration: None I found a number of resources and have focused on secondary evidence or evidence published by the NHS (we’re based in the UK and have high levels of trust)! Having said that there appears to be no consensus! Firstly, the Canadian Therapeutics Letter report : “Deprescribing Tapering over a few days or weeks may avoid potentially significant withdrawal symptoms such as diaphoresis, anxiety, palpitations, confusion. Dangerous adverse effects (e.g. falls, severe cognitive impairment, sedation or edema) require abrupt deprescribing.” Then, two NHS prescribing groups offer differing advice: “Gradual dose taper allows observation of emergent symptoms that may have been controlled by the drug. Gabapentin: (total daily dose > 900 mg) Reduce total daily dose by 300 mg every 10 days (range 7-14 days) Gabapentin: (total daily dose ≤ 900 mg) Reduce total daily dose by 100 mg every 10 days (range 7-14 days)”  AND “The summary of product characteristics for gabapentin and pregabalin indicate that both drugs can be discontinued over one week. A more gradual dose taper allows observation of emergent symptoms that may have been controlled by the drug.”  The latter reference (URL below) also gives an example of a withdrawal schedule. References 1) https://www.ti.ubc.ca/wordpress/wp-content/uploads/2019/02/117.pdf 2) http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2019/01/5.-Pregabalin-and-Gabapentin-Withdrawal-Summary-Guidance.pdf 3) https://www.hey.nhs.uk/wp/wp-content/uploads/2016/03/pregabalin.pdf