Pregabalin is the generic name of a drug that we use to treat some types of chronic pain,
like fibromyalgia and neuropathic pain. In this video, I will answer the 10 most common
questions that people ask me about pregabalin: 1. Are pregabalin and gabapentin the same?
2. What is the correct dose of pregabalin? 3. How does pregabalin work for pain?
4. Which class of drug is pregabalin? 5. What to do when pregabalin doesn’t
work for my pain? 6. Does pregabalin cause
any damage to the liver or kidneys? 7. Will pregabalin make you sleepy
or cause weight gain? 8. Can you drive or can
you take alcohol with pregabalin? 9. Is pregabalin good for anxiety?
10. Why pregabalin is not a controlled substance? So, let’s talk about pregabalin today.
1) Are pregabalin and gabapentin the same? No, these are two different drugs.
Pregabalin is C8 H17 NO2 Gabapentin is C9 H17 NO2
Both pregabalin and gabapentin are second generation anticonvulsant medications,
and both are classified as gabapentinoids. I have another video that I talk about gabapentin.
If you go to the description of this video below you will see a link to that other video.
Pregabalin is more potent than gabapentin and therefore is used at lower doses.
Which takes me to the next question. 2) What is the correct dose of pregabalin?
The maximum dose per day is 600 mg. We use it twice a day. So
the maximum would be 300 mg in each dose. We usually start at low doses of 25 mg once a day
just to let the body adapt to the side effects. Then we tell the person to take twice a day.
We increase the dose slowly to give time to see if the person is not too sedated or dizzy.
We usually don’t see any pain relief at lower doses. The person will notice the pain is
better when they can achieve at least 300 mg per day, which means 150 mg two times a day.
Before I continue, let me remind you that this video is not intended to replace medical advice.
It is for educational purposes only. You should contact your doctor for a proper diagnosis and
treatment plan for you. In case of emergency, go to the nearest emergency department or call 911.
3) How does pregabalin work for pain? Pregabalin binds to a receptor in the
nerve system and reduces the release of substances that stimulates the pain
sensations that arrive at the brain. If you have seen the other video that
I explain what chronic pain is, you will remember that there are ascending pathways
from the periphery to the brain, and descending pathways from the brain to the periphery.
Well, the gabapentinoids, both pregabalin and gabapentin, they block the ascending pathways,
so there are less electrical impulses arriving at the brain level, at the conscious brain,
therefore, the brain will receive less bombarding from impulses arriving from the rest of the body.
In addition, pregabalin also mimics the endogenous neurotransmitter GABA.
GABA is one of the main inhibitors of nerve and brain activity.
When the brain needs to slow down, to block some activity, it will release GABA.
Well, pregabalin can mimic GABA and supress
a lot of brain activity. That can be a good thing if the person is having pain and anxiety,
but it can also be a bad thing if the person needs to concentrate and stay alert.
Because pregabalin is an anticonvulsant medication, it has antiepileptic properties,
so it can be used to treat seizures.
So, in summary pregabalin can be used for a variety of conditions
For pain because its neuromodulation properties in the pain system
For anxiety And for seizures
4) Which class of drug is pregabalin? Pregabalin is an anticonvulsant medication, but
we don’t use it because the person has seizures. We are using the term neuromodulator. So if
someone asks me today what class of medication is pregabalin? I answer it is a neuromodulator.
5) What to do when pregabalin doesn’t work for my pain?
Unfortunately not everyone with chronic pain will have pain relief with pregabalin.
If they don’t see at least 30% pain relief, then it is not working for them.
It is very rare to achieve 100% pain relief for chronic pain with pregabalin.
So, here are some reasons why pregabalin is not working for you:
1. You didn’t get to a high enough dose yet. A lot of patients have to stop early,
at lower doses because of side effects 2. If you were on a high enough dose,
then, it could be that you didn’t try for long enough. I tell patients that when you get to the
therapeutic dose, of at least 300 mg per day, then they need to wait between 2 to 6 months
for their nerve system to readjust. 3. You were not taking the medication
twice a day. I know some patients don’t like to take pregabalin in the morning because of
the sleepiness or dizziness. But if they only take once a day, then there is no way to know
if the drug is benefiting them or not. 4. Or maybe the type of pain that you
have is not responsive to pregabalin. There is a recent Cochrane review that
summarized 45 randomized controlled trials of pregabalin for neuropathic pain in adults.
The conditions that they included in this review were:
Post-herpetic neuralgia Painful diabetic neuralgia
Mixed neuropathic pain Central pain
HIV neuropathy Back pain with radiculopathy
Neuropathic cancer pain And painful polyneuropathy
You know what their conclusions were? That there is efficacy of Pregabalin
in postherpetic neuralgia, painful diabetic neuralgia, and mixed or
unclassified post-traumatic neuropathic pain and absence of efficacy in HIV neuropathy
and inadequate evidence of efficacy in central neuropathic pain
There is another Cochrane review of Pregabalin for Fibromyalgia that was updated in 2016.
They found 8 randomized trials. It is interesting that the
authors of the review looked at the efficacy outcome with different doses of pregabalin.
They found 1 study of 263 patients that took 150 mg per day, and there was no
benefit of pregabalin compared to placebo. You see that with increased dose the proportion
of patients who had a good outcome, in this case at least 30% pain intensity reduction,
or at least 50% pain intensity reduction was significantly different from placebo.
So, they concluded Pregabalin 300 to 600 mg produces
a major reduction in pain intensity over 12 to 26 weeks with tolerable adverse events for a small
proportion of people (about 10% more than placebo) with moderate or severe pain due to fibromyalgia.
The degree of pain relief is known to be accompanied by
improvements in other symptoms, quality of life, and function.
The authors of this review also included trials that compared pregabalin
to other medications that are approved for fibromyalgia. They found results are similar
of pregabalin to other effective medicines in fibromyalgia milnacipran and duloxetine.
6) Does pregabalin cause any damage to the liver or kidneys?
Usually we are not concerned that pregabalin will be toxic
to the liver or kidney, even if the person needs to use pregabalin for the rest of their lives.
It is important to know if the patient already has a liver or kidney function
problem before they start using pregabalin because their dose needs to be adjusted.
They will require a lower dose than people who do not have a liver or kidney function problem.
Which brings me to the next question, about the side effects of pregabalin.
7) Will pregabalin make you sleepy or cause weight gain?
The answer is yes. The most common adverse effects
of pregabalin are dizziness, somnolence, weight gain, leg swelling, and dry mouth.
But there are many other potential adverse effects that I am not listing here as they are too many.
8) Can you drive or can you take alcohol with pregabalin?
The short answer is no. If you feel that you are
dizzy and sleepy you should not be driving a car or operating any heavy equipment.
You could cause injury to yourself and others.
Taking with alcohol makes you more sleepy and dizzy.
9) Is pregabalin good for anxiety? Pregabalin has sedating effects,
and those can be helpful to people who suffer form anxiety disorders. They are used in
combination with other anxiolytic medications to treat generalized anxiety, for example.
However, it is important to remember that if you stop taking your daily duloxetine your body
will have withdrawal symptoms. Those abstinence symptoms may
include anxiety, insomnia and headache. But this is not the same thing as being addicted
to pregabalin. There is no such thing as addiction to pregabalin. The person may develop dependence,
the same way that people can develop physical dependence on thyroid hormones or blood pressure
medications. If they stop any of those medications abruptly, they have withdrawal symptoms. It does
not mean they are addicted to their thyroid hormones or blood pressure medications.
10) Why pregabalin is not a controlled substance? As I explained before, there is no risk of
someone getting addicted to pregabalin. I know people may abuse pregabalin, but people
can also abuse acetaminophen, anti-inflammatories or anti-nausea medications. It doesn’t mean
all these drugs need to be controlled by the government because people abuse them.
So, I hope these answered your 10 top questions about pregabalin.
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