Gabapentin Withdrawal: Timeline, Symptoms and Detoxification

Gabapentin is a prescription medication frequently prescribed for managing nerve pain, controlling seizures, addressing alcohol use disorder, alleviating alcohol withdrawal symptoms, and treating insomnia. Initially regarded as a safe, non-addictive option, gabapentin gained widespread use for chronic pain and neurological disorders. In 2017 alone, gabapentin was prescribed 68 million times, ranking it as the tenth most commonly prescribed medication in the United States.

Although the Food and Drug Administration (FDA) does not classify gabapentin as a controlled substance at the federal level, several states have implemented stricter regulations and reclassified it as a controlled substance. This shift is primarily due to the increasing risks of misuse and the potential for developing physical dependence, which can lead to withdrawal symptoms when discontinuing the drug.

Can Gabapentin Lead to Withdrawal?

Withdrawal from gabapentin occurs when an individual becomes physically dependent on the medication, meaning their body relies on it to function normally. When a dependent person ceases using gabapentin, withdrawal symptoms may emerge.

Dependence on gabapentin can develop whether the drug is used alone or in combination with other substances, particularly when misused. The risk of dependence typically arises anywhere from three weeks to five years after initiating the medication. Higher dosages elevate the likelihood of dependence and the severity of withdrawal symptoms upon discontinuation. Misuse of gabapentin involves taking doses higher than prescribed or combining it with other substances, such as opioids.

Symptoms of Gabapentin Withdrawal

Withdrawal symptoms from gabapentin often manifest after abruptly stopping the medication or rapidly reducing the dose. Common symptoms include:

• Excessive sweating
• Agitation
• Anxiety
• Confusion
• Disorientation
• Headaches
• Insomnia

Additionally, there are reports of less common withdrawal symptoms, such as:

• Upper respiratory tract infection-like symptoms
• Chest pain
• Elevated blood pressure
• Restless limb movements
• Seizures

Seizures During Gabapentin Withdrawal

Abruptly stopping gabapentin without medical supervision can increase the risk of seizures, especially in individuals with a history of seizures. Studies have indicated that seizures can occur even in those who have never previously experienced them after suddenly discontinuing gabapentin.

Timeline of Gabapentin Withdrawal

Withdrawal symptoms from gabapentin typically appear within 12 hours to seven days after cessation. Most individuals begin to experience symptoms within one to two days.

The onset of withdrawal symptoms is swift due to gabapentin’s short half-life, which is approximately five to seven hours. In individuals with kidney disease, the half-life may be extended. Generally, it takes around five half-lives for gabapentin to be completely eliminated from the body, translating to roughly 35 hours after the last dose.

Abruptly stopping gabapentin or reducing the dose too quickly can trigger withdrawal symptoms. To minimize these effects, it is recommended to gradually taper the dose. In some cases, tapering the gabapentin dose can take up to 18 weeks to fully discontinue the medication while managing withdrawal symptoms effectively.

Managing Gabapentin Withdrawal

Withdrawal from gabapentin can be both uncomfortable and potentially life-threatening. Strategies to manage withdrawal symptoms include:

• Resuming gabapentin
• Taking magnesium supplements
• Gradually tapering the gabapentin dosage
• Engaging in regular exercise and maintaining a healthy diet

Currently, there are no standardized guidelines for managing gabapentin withdrawal. In severe cases, restarting gabapentin can alleviate withdrawal symptoms within three days. However, the most effective approach remains a gradual tapering of the dosage.

Magnesium for Gabapentin Withdrawal

Supplementing with magnesium during a gabapentin taper, ideally taking magnesium at least two hours after a gabapentin dose, may help reduce withdrawal symptoms. Research has shown that magnesium can lessen the severity of withdrawal symptoms by affecting calcium channels and neuromediators such as dopamine, serotonin, and glutamate.

It’s important to separate the timing of magnesium supplements from gabapentin doses to prevent magnesium from binding to gabapentin, which can reduce the absorption of gabapentin and potentially trigger withdrawal symptoms.

Lorazepam for Gabapentin Withdrawal

Benzodiazepines like lorazepam are commonly used to manage withdrawal symptoms from opioids and alcohol. Although gabapentin withdrawal shares similarities with these substances, studies and case reports have demonstrated that benzodiazepines are generally ineffective in mitigating gabapentin withdrawal symptoms.

Gradual Tapering

The most reliable method for controlling gabapentin withdrawal symptoms is to slowly taper the dosage. Tapering protocols should be individualized, similar to those used for opioid tapering, and adjusted based on the individual’s need for symptom management.

Exercise

Incorporating physical activity can improve pain management, enhance physical function, and boost overall quality of life. Even light to moderate exercise can increase dopamine levels in the brain, which activates reward pathways affected by drug dependence and balances the dopamine decrease experienced during withdrawal.

Establishing a consistent exercise routine not only helps ease withdrawal symptoms and improve mood but also aids in preventing cravings post-withdrawal. Consulting a healthcare provider to determine the appropriate type and amount of exercise is advisable.

Healthy Diet

Maintaining a nutritious diet can help alleviate certain withdrawal symptoms and provide the necessary nutrients and energy for recovery. A balanced diet can enhance overall health and mood. Recommendations for healthy eating during withdrawal include:

• Consuming low-fat foods
• Eating foods high in protein, complex carbohydrates, and fiber
• Avoiding high-calorie, low-nutrient snacks like sweets
• Maintaining regular meal times
• Adding vitamin and mineral supplements as advised by a healthcare provider

How to Discontinue Gabapentin Safely

It is crucial not to abruptly stop taking gabapentin or rapidly reduce the dose without medical guidance. Under the supervision of a healthcare provider, a gradual tapering of the gabapentin dose over several weeks is recommended. Although there is no universal tapering schedule, a common approach is to decrease the dose by approximately 25% with each reduction.

Tapering should be done slowly, potentially over weeks or months, depending on individual tolerance. Close monitoring is essential during the tapering process to adjust dosages for the elderly, those with kidney disease, or individuals experiencing adverse events and withdrawal symptoms.

Always follow the tapering plan provided by your healthcare provider. Below is an example of a possible gabapentin taper schedule:

Gabapentin Taper Schedule

Day	Total Daily Dose (mg)	Directions
1-3	2400 mg	Take 1200 mg by mouth twice daily for 3 days.
4-6	1800 mg	Take 900 mg by mouth twice daily for 3 days.
7-9	1200 mg	Take 600 mg by mouth twice daily for 3 days.
10-12	800 mg	Take 400 mg by mouth twice daily for 3 days.
13-15	400 mg	Take 200 mg by mouth twice daily for 3 days.
16-18	200 mg	Take 100 mg by mouth twice daily for 3 days.
19-21	100 mg	Take 100 mg by mouth once daily for 3 days, then STOP.

Medically Supervised Gabapentin Detox

Detoxifying from gabapentin involves the body eliminating the drug, which can be managed safely with professional assistance. While some individuals may successfully taper off gabapentin at home following a prescribed schedule, others may require a more controlled environment due to the risk of severe withdrawal symptoms.

Individuals with a history of severe gabapentin withdrawal, such as seizures or other pre-existing health conditions, should undergo detoxification in a setting where they can receive constant medical supervision. Medically supervised detox provides 24-hour care from trained medical professionals to ensure safety and comfort throughout the process.

Detox is particularly important for those addicted to multiple substances, known as polysubstance abuse. Approximately 15% to 20% of individuals with opioid use disorder also misuse gabapentin, heightening the risk of abuse. Programs like the detox program at The Recovery Village Salem offer comprehensive support for those needing to detox from multiple substances simultaneously.

Our Gabapentin Detox Program in Salem, OR

Managing gabapentin detox on your own can be challenging and exhausting both physically and emotionally. Professional detox centers provide a safer, more comfortable experience through comprehensive care.

The Recovery Village Salem offers complete support from intake through the entire recovery journey. Our accredited medical detox facility provides round-the-clock care from licensed healthcare professionals who oversee the detox process and address withdrawal symptoms. Following detox, our inpatient and outpatient programs are available to support a drug-free lifestyle.

If you or a loved one is struggling with gabapentin addiction, The Recovery Village Salem is here to assist. Contact us today to learn more about our gabapentin detox and addiction treatment programs and discover how we can support you on your path to recovery.