Purpose: Pain management is complicated by unacceptable levels of opioid abuse with few safe alternatives. The need exists for therapies of limited abuse potential and established pathways for their safe use. Antiepileptic drugs (AED) have been used as adjuncts to pain management since the 1960’s. By virtue of their pharmacokinetic and adverse event (ADR) risk profiles, antiepileptic drugs require more prescriber surveillance compared to other medications. However, there is no published standard approach for discontinuing these drugs. The objectives of this review were to summarize the risk profile associated with tapering antiepileptic drugs used for epilepsy vs. AED use in pain management and to identify best practices for safe tapering. Methods: A retrospective review of the literature was performed, addressing discontinuation of antiepileptic drugs. Articles were collected from PubMed and Ovid using keywords: anticonvulsant, antiepileptic, withholding treatment, taper and withdrawal. The limitations included English language only publications, regardless of country of origin, and publication between 1990 and 2013. Results: A search of the literature revealed 25 published randomized controlled trials, reviews, case reports and editorials. While no taper guideline was found, many studies used a gradual taper protocol ranging from one month to more than four years for discontinuation; however there was no consistency between protocols. Adverse events for continuation and inappropriate discontinuation of antiepileptic therapy were aggregated from FDA labeled information and published case reports constituting the risk profile. The risk profile in acute AED discontinuation when used for epilepsy versus use in pain management, are very different. In epilepsy, documentation of acute discontinuation of AEDs reported recurrence of epileptic episodes. Tapering therapy to discontinuation in epilepsy resulted in a higher risk of seizure recurrence within the first six months of discontinuation compared to patients continuing therapy. When used as adjuncts to pain management, acute discontinuation of AEDs was reported as a benzodiazepine-like withdrawal syndrome with symptoms such as diaphoresis, agitation and altered mental status. However unlike true benzodiazepine withdrawal, acute discontinuation of AEDs in pain management was unresolved by benzodiazepine administration. Conclusion: Tapering antiepileptic drugs when discontinuing therapy in epilepsy is common practice though there is no consistency amongst taper protocols documented in the literature. Tapering strategies for antiepileptic therapy when used in pain management are not well documented. This review identifies gaps in the literature concerning safe discontinuation of antiepileptic drugs when used in epilepsy as well as pain management. Further research is needed to establish safe tapering recommendations for AEDs which are specific to the applied use of the antiepileptic drug.