Gabapentin to Pregabalin Transition

Recommended Tapering Protocol

The Mayo Clinic recommends a gradual taper of gabapentin with a 10-25% reduction of the previous dose every 1-7 days while simultaneously initiating pregabalin therapy at 50mg three times daily or 75mg twice daily, then increase to 300mg/day after 3-7 days 1, 2
Pregabalin should be further titrated by 150mg/day every 3-7 days as needed up to 600mg/day (maximum dose) 2
Monitoring for withdrawal symptoms after each gabapentin dose reduction is crucial before proceeding to the next step, as recommended by the MMWR Recommendations and Reports 3

A cross-titration strategy can be employed, where pregabalin is started at an initial dose while maintaining the full gabapentin dose, then gabapentin is reduced by 10-25% while increasing pregabalin to a target dose of 300mg/day 1, 2

If withdrawal symptoms become severe, it is recommended to return to the previous well-tolerated gabapentin dose and slow the taper further, according to the MMWR Recommendations and Reports 3

The Mayo Clinic recommends dosage reduction of both gabapentin and pregabalin in patients with renal insufficiency 2
Pregabalin has linear pharmacokinetics and more straightforward dosing compared to gabapentin's nonlinear pharmacokinetics, as noted by the Mayo Clinic 2

The Mayo Clinic advises against tapering gabapentin too quickly and recommends starting pregabalin at lower doses if dose-dependent dizziness and sedation occur 2

Patients taking gabapentin as rescue doses less than once daily do not require formal tapering, according to the Mayo Clinic Proceedings 4