Management of disorders of pregabalin and gabapentin use

Overview of substance use and addictive behaviours explains key principles of care for a person with a disorder of substance use. Establishing a therapeutic relationship that engages the person (and ideally those close to them) is central to the management of substance dependence.

Note: The most important element of treatment for substance use is a therapeutic relationship.

Specialist advice on any aspects of care for patients with disorders of substance use is available and contact is encouraged; see Contact details for substance use clinical advisory services for clinicians.

Note: Specialist advice is available by phone on any aspect of the management of substance use; contact is encouraged.

Weaning of pregabalin or gabapentin can be undertaken in the outpatient setting for most people; inpatient rapid withdrawal can be considered for some patients. Consider specialist advice or referral to manage withdrawal of pregabalin or gabapentin if the patient has predictors or evidence of severe or complex withdrawal.

Offer alternative strategies (which may include group or individual psychosocial support) for managing other factors that precipitate or perpetuate prolonged use of pregabalin or gabapentin, such as insomnia, anxiety and chronic pain.

In patients using pregabalin or gabapentin for chronic pain, pain symptoms may be exacerbated as part of a withdrawal syndrome when stopping; seek advice on management as alternative analgesics may not be helpful in managing such conditions and continued use of pregabalin or gabapentin may be required with lower doses and closer supervision.

Substance use can pose risk of acute harms to the person (such as self-harm, falls and other accidents, suicide) and those around them (through impacts on driving, childcare, fitness to work and acute behavioural disturbances). For advice on managing these risks, see Ensuring the safety of a person with a disorder of substance use or addictive behaviour. For harm reduction measures to consider for any person with a disorder of substance use or addictive behaviour, see Harm reduction.

Elements of long-term management relevant to all disorders of substance use are covered in Long-term care in disorders of substance use and addictive behaviours.

Considerations for specific populations may be relevant in managing disorders of pregabalin and gabapentin use.