Pregabalin
A nerve-pain capsule that helps a minority of people a lot and many people not at all. Worth a careful trial; not worth staying on if it isn’t clearly helping.
Quick answer: Pregabalin (Lyrica) treats nerve pain, such as diabetic nerve pain, shingles pain and spinal cord injury pain, and is an add-on for epilepsy. Only about 1 in 4 to 1 in 3 people get a meaningful benefit. It doesn’t help sciatica or most back pain. Dizziness and sleepiness are very common, and weight gain, swelling and blurred vision are common. It can be misused and causes withdrawal if stopped suddenly, and it’s dangerous with opioids.
At a glance
- For
- Nerve (neuropathic) pain; add-on for focal epilepsy
- Works
- A meaningful benefit for a minority (about 1 in 4 to 1 in 3) with nerve pain
- Cost
- $25 a script on the PBS for neuropathic pain after other treatments ($7.70 concession)
- Kicks in
- Within 1–2 weeks; judge it after 4 weeks at a steady dose
- Dose
- Starts low (often 25–75 mg at night) and goes up slowly; lower in kidney disease
- Watch for
- Dizziness, sleepiness, unsteadiness, weight gain, swelling, blurred vision, feeling “high”
The “try it, then judge it honestly” medicine. If you can’t tell it’s helping at 4 weeks, it probably isn’t.
Brand names
- Lyrica, and generic pregabalin brands
How it works
Pregabalin attaches to calcium channels on overactive nerve endings and reduces the release of pain and excitement signals. It doesn’t touch ordinary inflammation pain.
Used for
- Neuropathic pain, e.g. diabetic nerve pain, after shingles, spinal cord injury (TGA-approved)
- Add-on treatment for focal seizures (TGA-approved)
- Off label: fibromyalgia (modest benefit for some), generalised anxiety (approved overseas)
- Doesn’t help: sciatica (no better than placebo in a large Australian trial) or most low back pain
Side effects
Dizziness and sleepiness affect more than 1 in 10. Weight gain, increased appetite, swelling of the legs, blurred vision, poor concentration, dry mouth and constipation are common. Some people feel euphoric, which is part of why it can be misused.
Full side-effect list (from the product information)
How often, from the official product information. Bold = serious.
Very common more than 1 in 10
- Dizziness
- Sleepiness
- Headache
Common 1 in 10 to 1 in 100
- Weight gain and more appetite
- Swelling of hands, legs or feet
- Blurred or double vision
- Unsteadiness, falls, tremor
- Poor memory or concentration
- Feeling high, confused or irritable
- Dry mouth, constipation, nausea or bloating
- Erection problems
- Feeling drunk
Uncommon 1 in 100 to 1 in 1,000
- Low mood or agitation
- Fainting
- Breathing problems (especially with opioids)
- Muscle pain
- Low blood sugar
Rare 1 in 1,000 to 1 in 10,000
- Severe allergic reactions or angioedema
- Heart failure
- Suicidal thoughts
- Kidney problems
Get help urgently if
- Slow or shallow breathing or extreme sleepiness, especially with opioids, alcohol or sedatives. Call 000
- Swelling of the face, lips or throat
- Thoughts of self-harm. Call Lifeline 13 11 14
- New breathlessness or major leg swelling
Good to know
- Opioids, alcohol, sleeping tablets: combining raises the risk of overdose and breathing problems.
- Driving: don’t drive until you know how it affects you.
- Stopping: taper over at least a week; stopping suddenly can cause anxiety, sweats, insomnia, nausea and, rarely, seizures.
- Misuse and dependence happen, especially with a history of substance use.
- Lower doses in kidney disease. Ask before pregnancy.
Common questions
Does pregabalin help sciatica?
No. A large Australian randomised trial found pregabalin was no better than placebo for sciatica, and it caused more side effects.
How long does pregabalin take to work?
Some benefit can start within 1–2 weeks. If you can’t clearly tell it’s helping after about 4 weeks at a steady dose, talk to your doctor about tapering off.
Can I stop pregabalin suddenly?
It’s best not to. Taper over at least a week to avoid withdrawal symptoms such as anxiety, insomnia, sweats and nausea.
Information only. Not a recommendation or endorsement of any product. Whether a medicine suits you depends on your health and other medicines, so talk to your doctor or pharmacist. In an emergency, call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
More information
- Lyrica product information (TGA)
- PBS: Pregabalin
- Mathieson S et al. Trial of pregabalin for acute and chronic sciatica (PRECISE, NEJM 2017)
- Cochrane: Pregabalin for neuropathic pain in adults (2019)
- Healthdirect: Medicines information
maladywise.com/medicines/pregabalin/