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Gabapentin Withdrawal — FRCA Final MCQ

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HardPain MedicineGabapentin WithdrawalFRCA Final

A 55-year-old man with chronic pain on long-term gabapentin 600 mg TDS is admitted for emergency surgery. Post-operatively his gabapentin is inadvertently omitted for 48 hours. He develops anxiety, tremor, diaphoresis, and a generalised tonic-clonic seizure. What is the most likely cause?

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Correct answer: E — Gabapentin withdrawal

Abrupt discontinuation of gabapentin after chronic use can cause withdrawal syndrome including anxiety, insomnia, nausea, pain, sweating, and seizures. The onset is typically 12-48 hours after the last dose. Gabapentin should never be stopped abruptly – it should be tapered over at least 1 week. In the perioperative setting, gabapentin should be continued (via NG tube if necessary) or converted to IV alternatives. This is an under-recognised cause of postoperative seizures.

Reference: BNF – 2025 – Gabapentin: withdrawal guidance; Faculty of Pain Medicine – 2022 – Perioperative pain management