Planned outpatient weaning of pregabalin and gabapentin

Before planning outpatient weaning, seek specialist advice or refer if any predictors or evidence of severe or complex withdrawal are present. Patients sometimes overestimate their consumption; seek corroboration of the doses they are being prescribed using real-time prescription monitoring if available, although this will not identify any drugs acquired illicitly. Observation in a hospital or specialist outpatient setting can help assess a patient’s tolerance by establishing whether they require their stated dose to avoid withdrawal; at least 24 hours of monitoring is recommended for patients who report that they take doses at the maximum end of the therapeutic rangeNSW Health, 2022.

International guidelines recommend gradual outpatient weaning at a rate of 50 to 100 mg pregabalin every 7 days or 300 mg gabapentin every 4 daysPublic Health England, 2014. Faster outpatient weaning can be considered if a patient has only used pregabalin or gabapentin for a short period.

Consider staged supply (dispensing small amounts of medication [eg daily, second daily or weekly]) and use of real-time prescription monitoring systems, if available.