A client taking pregabalin 150 mg twice daily for fibromyalgia says, "My pain is controlled, so I am going to stop it tonight." Which response should the nurse provide?
1"Skip tonight's dose, then restart pregabalin if pain returns because it works safely as an as-needed medication."
2"Stop pregabalin tonight and take diphenhydramine if insomnia or anxiety develops."
3"Take both daily doses together tomorrow morning, then discontinue the medication after 24 hours."
4"Contact the prescriber for a taper of at least 1 week because abrupt pregabalin withdrawal can cause symptoms."✓ Correct answer
Explanation
Pregabalin should be tapered gradually over a minimum of 1 week rather than stopped abruptly. Rapid discontinuation has been associated with insomnia, nausea, headache, anxiety, sweating, diarrhea, and increased seizure risk in clients with seizure disorders. The client should follow an individualized taper from the prescriber and should not convert scheduled therapy to as-needed use or combine doses.
Clinical reasoning Good symptom control does not remove physiologic adaptation to pregabalin. Abrupt cessation can trigger a discontinuation syndrome even when the drug is being used for pain rather than epilepsy.
Decision rule Do not stop pregabalin suddenly. Obtain a prescriber-directed taper of at least 1 week and monitor for withdrawal symptoms and return of the treated condition.
Scenario 45-year-old female on pregabalin 150 mg PO BID × 8 months for fibromyalgia, asking to stop abruptly today.
Pregabalin discontinuation — Withdrawal symptoms that can follow abrupt or rapid cessation of pregabalin therapy.
Gradual taper — Stepwise dose reduction over at least 1 week to reduce discontinuation reactions.
Physical dependence — Physiologic adaptation requiring continued use to avoid withdrawal; distinct from addiction.