Background. Concerns about inappropriate gabapentinoid prescribing persist even as global use continues to rise. Fear of adverse drug withdrawal reactions (ADWRs) is a major barrier to deprescribing, yet these reactions remain poorly described, limiting the development of clear guidance for safe and effective deprescribing. Objective. To examine the incidence, characteristics, severity, onset, and duration of gabapentinoid-related ADWRs. Methods. A systematic review of MEDLINE, Embase, PsycInfo, Cochrane, and Scopus was conducted to identify original research reporting gabapentinoid-related ADWRs. Two reviewers independently performed the screening, data extraction, and quality assessment. Results were summarised narratively. Results. From the 5,358 records screened, 54 articles were included (9 randomised controlled trials [RCTs], 3 pre-post, 1 cross-sectional, 1 pharmacovigilance, 40 case reports/series). Behavioural symptoms – agitation, insomnia, restlessness – were the most commonly reported ADWRs, alongside neuropsychiatric/cognitive, autonomic/physical, neurological/sensory, and gastrointestinal symptoms. Most reactions were mild-moderate, although 4 severe cases were identified. Onset and duration varied widely, from immediate occurrence and resolution following deprescribing, to delayed onset (up to 2 months) and prolonged duration (>6 months). ADWR incidence in RCTs ranged from 0-47%. Deprescribing methods included abrupt discontinuation (n=28 studies), tapering (n=23 studies), mixed approaches (n=2 studies), and one unspecified. Conclusions. The wide variation in gabapentinoid related ADWR presentation and incidence points to the need for improved prevention, early identification, and management. Evidence remains weak due to the predominance of case reports and series. Further high-quality research examining gabapentinoid type, dose, treatment duration, and deprescribing strategies is essential to guide tapering and reduce withdrawal related harm.