How long does gabapentin withdrawal last?

Case reports have shown that gabapentin withdrawal often lasts for 5 to 10 days, but some people have taken as long as 18 weeks to completely taper off gabapentin while managing withdrawal symptoms. Symptoms may start within 12 hours to 7 days after stopping gabapentin and may be severe. The withdrawal symptoms you develop and how long they last depend on your age, how much of the drug you are taking, how long you’ve been taking it for, what other medical conditions you have, and if you currently use drugs, substances, or alcohol.

Gabapentin was once considered a very safe, non-addictive drug, which has led to it being one of the top 10 prescribed drugs in the United States; however, it may not be as safe as once thought. Its FDA approved uses include partial seizures, nerve pain from shingles, and restless leg syndrome but it has also been prescribed off-label for alcohol use disorder and insomnia. Although it was developed to resemble the neurotransmitter GABA (gamma-aminobutyric acid) it does not bind to GABA receptors or alter GABA transport, but it does increase GABA levels so its effects may be due to inhibition of glutamate release.

If you have only used gabapentin for a short time at a low dose, withdrawing from gabapentin is not typically a problem. Most people who experience withdrawal symptoms from gabapentin have developed a physical dependence to it or have been misusing the drug. Physical dependence is when you start to build up a tolerance to the drug, and you may need to take even more of it to get the desired effect. This can develop after taking it for a few weeks or longer, especially if taking high dosages. Misusing gabapentin means taking gabapentin in higher dosages than your doctor has prescribed or taking it for reasons not intended by your doctor. A study on gabapentin abuse from 1993 through 2015 showed that people who experienced withdrawal were taking an average of 3,000 mg (600 to 8,000 mg) of gabapentin per day, but some case reports mention withdrawal symptoms after taking dosages of 400 to 800 mg per day for at least 3 weeks.

Gabapentin withdrawal syndrome has similarities with symptoms of alcohol and benzodiazepine withdrawal. This may be because all three substances have some effect on GABA. If you are taking gabapentin at a normal dose prescribed by your doctor and you don’t have a history of substance abuse, you are less likely to have withdrawal symptoms when you stop taking gabapentin.

What happens when you suddenly stop taking gabapentin?

Gabapentin should not be stopped suddenly without talking to a healthcare provider. Stopping it suddenly can increase your risk of having withdrawal symptoms, including withdrawal seizures. An older age, higher dosages, physical dependence, and a history of substance or alcohol misuse put you at a higher risk of gabapentin withdrawal symptoms, especially if you stop gabapentin suddenly.

Your brain cells (neurons) become dependent on a high dose of the drug for normal functioning. When the drug is stopped, your brain becomes temporarily disorganized. If you are starting to feel that you need a higher dosage of gabapentin to function, then you are most likely physically dependent on it and stopping suddenly will likely lead to withdrawal symptoms. The withdrawal symptoms may be bad enough to force you to start taking gabapentin again.

Common gabapentin withdrawal symptoms

Gabapentin withdrawal symptoms may start within 12 hours or take up to 7 days to begin after stopping suddenly. Symptoms commonly include:

• Restlessness (agitation)
• Anxiety or nervousness
• Agitation
• Body/stomach pain
• Confusion
• Disorientation
• Dizziness
• Excessive sweating
• Headaches
• Nausea
• Sleeplessness.

Less common symptoms include:

• Depressed mood, dark thoughts, or thoughts of suicide
• Heart palpitations
• High blood pressure
• Muscle twitching
• Light sensitivity
• Respiratory tract infections, such as the cold or flu
• Restless limb movements
• Seizures.

Some people may require intensive monitoring and management in a hospital or treatment center if they are displaying severe withdrawal symptoms.

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What is the treatment for gabapentin withdrawal?

There are no approved medications to treat gabapentin withdrawal. The only reliable treatment is to slowly taper the drug under the supervision of your doctor, usually a substance abuse specialist. This may be done over a period of 3 weeks of longer. If withdrawal symptoms become too severe, the dose of gabapentin is increased again to ease these symptoms, before resuming a slower tapering schedule. Restarting gabapentin typically stops withdrawal symptoms within 3 days. Some people may take many months to slowly withdraw from gabapentin.

Some addiction centers have used magnesium or lorazepam during gabapentin withdrawal, although there is no evidence to suggest that they work for everyone. If magnesium supplements are used, they should be taken at least two hours after the dose of gabapentin because they may affect the absorption of gabapentin, leading to more severe withdrawal symptoms.

Exercise, a healthy diet, and sleep can also help.

Tapering gabapentin

Tapering protocols vary and they should be individualized to meet the needs of the person stopping gabapentin. Table 1 is an example of a gabapentin tapering schedule but this may not suit everyone.

Table 1. Example of a gabapentin taper chart (45 days/7 weeks)

How can I avoid gabapentin withdrawal?

The best way to avoid gabapentin withdrawal is to only take the dose prescribed by your doctor, for the shortest time possible. When it comes time to stop it, talk to your healthcare provider about a tapering schedule.

Do not misuse substances or alcohol while you are taking gabapentin.

What is gabapentin used for?

Gabapentin is a prescription medication approved to treat certain types of seizures and nerve pain that follows a herpes infection (postherpetic neuralgia). A long-acting form is used to treat restless legs syndrome. The most common brand name is Neurontin.

Gabapentin is also prescribed and used for unapproved reasons. These are called off-label uses. Off-label uses for gabapentin include:

• Substance abuse treatment
• Migraine headaches
• Fibromyalgia
• Mental health disorders
• Insomnia.

People with a history of drug or alcohol abuse may be at increased risk for:

• Tolerance
• Self-dose escalation
• Drug-seeking behavior
• Withdrawal symptoms.