A gabapentinoid (controlled drug)
Pregabalin
A gabapentinoid for nerve pain, epilepsy and generalised anxiety that settles over-active nerve signalling — effective, but a controlled drug with dependence, sedation and serious opioid-interaction risks.
What is Pregabalin?
Pregabalin is a gabapentinoid used for nerve (neuropathic) pain, as an add-on in some forms of epilepsy, and also for generalised anxiety disorder. It works by calming overactive nerve signalling in the brain and nervous system.
Education and reference only. This is a plain-language guide to Pregabalin — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Pregabalin is a gabapentinoid used for nerve (neuropathic) pain, as an add-on treatment in some forms of epilepsy, and — unlike its relative gabapentin — also as a treatment for generalised anxiety disorder. It is often chosen for nerve pain when a more predictable, twice-daily option is wanted, as it is absorbed more steadily and reliably than gabapentin. Like gabapentin it is a UK controlled drug (Class C, Schedule 3), because it can be misused and can cause dependence, so it is prescribed and monitored with extra care.
How it works
Pregabalin binds to the same alpha-2-delta part of the calcium channels on nerve endings as gabapentin and reduces the release of the messengers that carry pain, seizure and anxiety signals. By calming this over-active signalling it eases neuropathic pain, helps stabilise seizure activity and dampens the heightened nerve responses involved in anxiety. Compared with gabapentin, pregabalin is absorbed more consistently and predictably, which is one reason its effect tends to be steadier — but the underlying action on the nervous system, and the sedation and dependence potential that come with it, are similar.
Company & origin
Originated / developed by: Parke-Davis / Pfizer (discovered at Northwestern University by Richard Silverman).
Pregabalin was designed around 1989 from publicly funded research in Richard B. Silverman's laboratory at Northwestern University, USA, and licensed in 1990 to Parke-Davis (later Pfizer) for development. It received US FDA approval in 2004 and is marketed by Pfizer as Lyrica.
What it treats
Conditions Pregabalin is used for
Practical use
How to take Pregabalin
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Usually started low and increased gradually, so stick to the build-up plan you are given.
- Can be taken with or without food, spaced through the day as directed.
- Do not stop it suddenly after regular use; reduce slowly with advice to avoid withdrawal and, in epilepsy, seizures.
- It can cause drowsiness and dizziness, so be cautious with driving until you know how it affects you, and avoid alcohol.
- If you miss a dose, take it when you remember unless the next is nearly due; do not double up.
Weighing it up
Advantages & disadvantages of Pregabalin
Advantages
- Effective for nerve pain, generalised anxiety and as add-on epilepsy treatment.
- Often works at a relatively low frequency of dosing through the day.
- Can be titrated to balance benefit against side effects.
- Taken by mouth and broadly tolerated when introduced gradually.
Disadvantages
- Commonly causes drowsiness, dizziness and weight gain.
- Has a recognised potential for dependence and misuse and is a controlled drug in the UK.
- Must be tapered slowly rather than stopped abruptly.
- Can cause dangerous over-sedation and breathing problems if combined with opioids or other sedatives.
Practical use
Good to know
Pregabalin is started low and built up gradually to limit drowsiness and dizziness, and it is usually taken in divided amounts across the day. Because it is a controlled drug, there are extra prescribing rules, and it carries a genuine risk of dependence and misuse — it produces a calming, sometimes euphoric effect that some people seek, so it is treated with respect and never shared. It must be tapered slowly when stopping, as abrupt withdrawal causes symptoms and can provoke seizures. As with gabapentin, the standout danger is combining it with opioids, which can seriously slow breathing; weight gain and drowsiness are common.
Who should not take it / use with caution
- People with a history of substance misuse or dependence need careful assessment, as pregabalin can be misused and cause dependence — its misuse potential is regarded as somewhat higher than gabapentin's.
- Used with particular caution alongside opioids and other sedating medicines because of the risk of dangerously slowed breathing.
- The amount is reduced and built up especially carefully in people with reduced kidney function, as the body clears it through the kidneys, and care is needed in older or frail people.
Monitoring
- Response and side effects, especially when building up the amount
- Signs of dependence, misuse, euphoria or excessive sedation
- Kidney function where relevant, and breathing if used with opioids
Side effects
- Drowsiness, dizziness and unsteadiness, particularly when starting or increasing — a falls risk in older people.
- Weight gain, increased appetite, fluid retention with swollen ankles, blurred vision and dry mouth.
- Less commonly, mood changes or euphoria, and — importantly — slowed or shallow breathing when combined with opioids or other sedatives, which can be life-threatening.
Key interactions
- Opioids markedly increase the risk of slowed breathing, deep sedation and death — the most serious interaction, requiring caution and monitoring.
- It adds to drowsiness from alcohol, benzodiazepines, sleeping tablets and other sedating medicines.
- Few direct drug-level interactions, but its sedating and dependence-related effects compound those of similar medicines.
Available as: Capsules, tablets and an oral solution (liquid) for those who cannot manage capsules or tablets.
Answers
Pregabalin: frequently asked questions
How is pregabalin different from gabapentin?
They are close relatives that work in the same way, but pregabalin is absorbed more steadily and reliably, so its effect tends to be more predictable, and it is usually taken twice a day. Pregabalin is also licensed for generalised anxiety, which gabapentin is not. Both are controlled drugs with dependence potential; pregabalin's misuse risk is generally regarded as a little higher.
Why is pregabalin a controlled drug?
Pregabalin is a Class C, Schedule 3 controlled drug in the UK because it can be misused — some people take it for its calming or euphoric effect — and it can cause dependence. This brings stricter prescribing and dispensing rules. Used as prescribed it is a valuable medicine, but it should be taken exactly as directed and never shared with others.
Can I stop pregabalin suddenly?
No — stopping pregabalin abruptly can cause withdrawal symptoms such as anxiety, sleep problems, sweating and nausea, and in people with epilepsy it can provoke seizures. It should always be reduced gradually under your prescriber's guidance. If you want to come off it, discuss a tapering plan rather than stopping on your own.
Why is mixing pregabalin with opioids so dangerous?
Both pregabalin and opioids slow the brain and breathing, and together the effect is much greater than either alone, with a real risk of dangerously slow, shallow breathing. This combination has caused deaths. If you are prescribed both, it will be done with caution — watch for heavy drowsiness or slowed breathing and seek urgent help if they happen.
What is the difference between pregabalin and Lyrica?
They are the same medicine — pregabalin is the generic (active-ingredient) name and Lyrica is a brand name. Generic pregabalin contains the identical active ingredient and works in the same way. The same controlled-drug status and safety advice apply whichever you are given.
The wider class
About Gabapentinoids
Pregabalin belongs to the gabapentinoids class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF: Pregabalin.
- electronic Medicines Compendium (SmPC): Pregabalin (Lyrica).
- NICE CKS: Pregabalin.
- MHRA: Gabapentin and pregabalin - risk of respiratory depression and reclassification as controlled drugs.
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