Gabapentin Withdrawal: Symptoms, Timeline, & How to Stop
Last Updated: October 28, 2022
Most people who stop using gabapentin do not experience withdrawal symptoms or report only mild symptoms. However, some people experience uncomfortable side effects that make stopping gabapentin difficult. There are very few case studies or verified reports of gabapentin withdrawal, but anecdotal evidence on drug forums may suggest that gabapentin withdrawal occurs more often than is recognized by the medical community.
- Although gabapentin may be associated with dependence, there is little evidence that severe or prolonged withdrawal symptoms are common.
- The most common symptoms of gabapentin withdrawal are agitation, confusion, sweating, vomiting/diarrhea, tremors, high blood pressure and insomnia.
- For people who want to quit gabapentin, a controlled taper is the most effective way to minimize the risk of developing withdrawal symptoms.
- Quitting cold turkey is likely to increase the odds of experiencing withdrawal symptoms.
How Long Does Gabapentin Stay in Your System?
Gabapentin can stay in the system for a long time compared to other medications. All substances are eliminated at a constant rate called “half life,” and after five half lives, the majority of the substance is eliminated from the body. Half life measures how long it takes the body to remove half of the drug.
Several factors influence how long gabapentin will stay in the system, the most important being kidney function. Other factors include age, presence of other substances, gastrointestinal function and how long a person has been taking gabapentin.
Gabapentin’s half-life for most people is 5–7 hours if they have normal kidney function. Based on this number, gabapentin stays in the body for approximately 25–35 hours.
People with impaired kidney function need to be especially careful when taking gabapentin. If prescribed to you, your healthcare provider should monitor kidney function and dose appropriately. People with impaired kidney function can expect the gabapentin half life to increase to up to 52 hours, and therefore take over 10 days to clear the body.
Can You Stop Gabapentin Cold Turkey?
Not much is known about the withdrawal and addiction potential of gabapentin, and therefore the medical community doesn’t know as much about stopping gabapentin “cold turkey” when it is being misused. Since gabapentin’s effects are similar to alcohol, stopping gabapentin may be similar to stopping alcohol “cold turkey.”
In medical settings, it is common to taper gabapentin slowly so that withdrawal effects do not emerge. Since gabapentin slows neuronal signals, stopping without a taper can lead to withdrawal symptoms similar to alcohol, like tremor, agitation, anxiety and seizures.
It’s worth noting that there are approximately 64 million prescriptions written annually for gabapentin, and it is the 10th most commonly prescribed drug in the US. The fact that there are only a few dozen or so verifiable cases of gabapentin withdrawal dating back over a decade supports the idea that gabapentin withdrawal is relatively uncommon. However, the fact that withdrawal can occur means that people reporting withdrawal symptoms should be taken seriously.
What Causes Gabapentin Withdrawal?
Gabapentin withdrawal is caused by stopping it after the body has become dependent on gabapentin in order to function normally. Otherwise, very little is known about gabapentin withdrawal, and only a few dozen published case studies exist that provide real insight. With few exceptions, each case describes a patient who was taking at least 3,600 mg of gabapentin per day, with the maximum dose reported to be 12,000 mg per day.
In cases where people took less than 3,600 mg/day, very serious health issues were present, including a history of severe alcohol use disorder, liver cirrhosis and continued chronic heavy alcohol consumption in one patient taking 900 mg/day.
When Does Gabapentin Withdrawal Start?
The answer to this question is unclear, but it is possible to use information from other medications to develop an informed estimate. If gabapentin leaves the body 25–35 hours after the last dose, then withdrawal symptoms are likely to appear 1–2 days after the last dose. Based on different case studies, symptoms can start 12 hours to seven days after stopping gabapentin, with most seeing symptoms on days 1–2
How Long Does Gabapentin Withdrawal Last?
It is not clear how long gabapentin withdrawal symptoms last. The case reports available for review are often unclear because patients are usually restarted on gabapentin to manage the withdrawal symptoms.
Gabapentin Withdrawal Symptoms
Since gabapentin works in a similar way to alcohol and benzodiazepines, withdrawal symptoms are also similar. Symptoms may include:
- Clammy skin
- Fast heart rate
- Loss of appetite
- Mood swings
- Tremor or shakiness
Among the published literature, the most common withdrawal symptom is agitation, followed by confusion, excessive sweating, gastrointestinal symptoms and a few reports of tremors, insomnia, increased heart rate and elevated blood pressure. One case of each involved akathisia or an inability to sit still, catatonia or repetitive motions or muscle rigidity and a state of mental stupor, and seizures.
Some researchers have proposed that gabapentin withdrawal symptoms are similar to those of delirium tremens, which are associated with severe alcohol withdrawal. Hallmark symptoms of delirium tremens include confusion, agitation, dissociation and hallucinations. However, more research is required in order to determine whether delirium tremens and gabapentin withdrawal are mechanistically similar. Remember that not all published reports of gabapentin withdrawal symptoms parallel those of delirium tremens.
Anecdotal reports on drug forums report symptoms of gabapentin withdrawal including agitation, confusion, sweating, vomiting/diarrhea and insomnia, but also include occasional reports of far more diverse symptoms. Rare symptoms include widespread soft tissue pain, stuttering, phobias, and ringing/buzzing in the ears. People report symptoms lasting for anywhere from a couple of days to a couple of months. However, there are also frequent interjections from people who quit cold turkey and reported no withdrawal symptoms.
At this time, predicting gabapentin withdrawal symptoms is difficult if not impossible. The subjective experience of withdrawal may also be quite different between individuals.
Gabapentin Withdrawal Timeline
Both published and anecdotal reports indicate that withdrawal symptoms set in within 1–7 days of stopping gabapentin.
Most people mentioned in gabapentin case studies were maintained long-term on low doses after their withdrawal experiences. The minority reported that their symptoms abated “over time”. Based on published literature, a reliable gabapentin withdrawal timeline is impossible to determine.
Anecdotal reports suggest that withdrawal symptoms may persist anywhere from 72 hours to one to two months, with symptom severity progressively abating over time. There does not seem to be a reliable dose-response relationship, meaning that even large doses of gabapentin may not cause any withdrawal symptoms, while a lower dose may be associated with symptoms. Unfortunately, very little is known about the mechanism of gabapentin withdrawal and why it affects some people but not others.
How to Stop Taking Gabapentin
If you are taking gabapentin and want to stop, speak with your doctor. Gabapentin withdrawal is not well-studied, so it is important to have a medical professional monitor the process to ensure comfort and safety. Since gabapentin withdrawal symptoms are similar to alcohol withdrawal symptoms, the process may be dangerous or life-threatening for some people.
The process of stopping gabapentin depends on how long you have been taking it and at what dosage. A healthcare professional can tailor the process to ensure that it’s done as safely and effectively as possible.
What Helps Gabapentin Withdrawal?
There is essentially nothing confirmed regarding what may help ease symptoms of gabapentin withdrawal. Even administering drugs such as opioids or benzodiazepines that affect similar pathways in the brain does not mitigate gabapentin withdrawal symptoms. Interestingly, gabapentin does mitigate symptoms of opioid or benzodiazepine withdrawal. The reason for this difference is unknown.
However, your doctor may choose to prescribe medications to manage mood- and anxiety-related withdrawal symptoms. Examples include fluoxetine, bupropion, sertraline and venlafaxine.
A taper is when the daily dose of a medication is slowly reduced. Tapers can help manage withdrawal symptoms by allowing the body to slowly adjust to less and less medication. There are not many medical guidelines for gabapentin tapers, but some sources suggest reducing the dose by 300 mg every four days. An example taper schedule is below:
- Day 1–4: 900 mg daily
- Day 5–8: 600 mg daily
- Day 9–12: 300 mg daily
- Day 13: Stop
The gabapentin detox period refers to the amount of time it takes for gabapentin to be completely eliminated from the body. Gabapentin has a half-life of approximately five to seven hours, meaning that it will be cleared within 35 hours. An unusual feature of gabapentin is that it is eliminated from the system without being appreciably metabolized, unlike opioids and benzodiazepines, both of which undergo significant metabolic processing and are eliminated largely as inert byproducts.
Anyone who is considering stopping gabapentin is urged to contact a medical professional who can develop and supervise an effective tapering program. Tapering gives the body time to adjust to gradually decreasing amounts of gabapentin.
Stopping gabapentin cold turkey is never recommended, as it presents a heightened risk of withdrawal symptoms occurring. A controlled taper as a part of a medical detox is the most reliable way to avoid withdrawal symptoms.
Medical detox is a program at many addiction treatment centers, and is considered the first step of substance use disorder treatment. In a medical detox program, a healthcare team manages withdrawal symptoms to make a person safer and more comfortable during the process.
Gabapentin Detox and Addiction Treatment Center
When used in conjunction with other drugs, particularly opioids, gabapentin may contribute to the overall addiction profile and affect withdrawal timelines. It remains unclear whether regular gabapentin misuse in conjunction with chronic opioid abuse can make opioid withdrawal worse. In fact, a number of studies report that gabapentin administration can substantially improve symptoms of withdrawal associated with opioids, benzodiazepines, and alcohol. Conversely, in cases of opioid overdose, the presence of gabapentin is significantly associated with higher mortality rates.
For those who are concerned about gabapentin detox and withdrawal symptoms, undergoing medically supervised detox can provide physical and psychological support. However, be cautious of any rehab facility that guarantees that they can prevent or treat gabapentin withdrawal. At this point, very little is understood about how gabapentin works and the mechanisms associated with gabapentin withdrawal.
If you or someone you love is struggling with a substance use disorder, The Recovery Village Columbus can help. Our facility has different programs available depending on your needs, including inpatient rehab, outpatient treatment and intensive outpatient treatment (IOP). Each program is facilitated by licensed medical and therapeutic professionals.
It’s never too late to start on the road to recovery. Help is only a phone call away. Do not hesitate to reach out if you or someone you know is struggling with gabapentin addiction.
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