Is Pregabalin Associated with Urinary Incontinence?
Yes, pregabalin is associated with urinary incontinence as a documented adverse effect, occurring in 1-2.7% of patients in clinical trials.
Evidence from FDA Drug Labeling
The FDA label for pregabalin explicitly lists urinary incontinence as an adverse reaction 1. In controlled trials:
- Neuropathic pain associated with spinal cord injury: Urinary incontinence occurred in 2.7% of pregabalin-treated patients versus 1.1% on placebo 1
- Postherpetic neuralgia trials: Urinary incontinence occurred in 1% of pregabalin patients (600 mg/day dose) versus 0% on placebo 1
- General urogenital adverse effects: The FDA label categorizes urinary incontinence as a "frequent" adverse reaction (occurring in ≥1/100 patients) 1
Supporting Research Evidence
Multiple lines of evidence confirm this association:
Case reports and observational studies document pregabalin-induced urinary symptoms. One case series described an 82-year-old man who developed confusion, urinary incontinence, and gait instability while on pregabalin, though this was complicated by concurrent hyponatremia 2.
Population-based epidemiological data from a community sample of 5,503 adults found anticonvulsants (including pregabalin) were associated with urinary incontinence, with a borderline significant association in women (OR 1.75; 95% CI 1.00-3.07) and a significant association in men (OR 2.50; 95% CI 1.24-5.03) 3.
Interestingly, animal studies suggest a paradoxical effect: Pregabalin actually improved neurogenic detrusor overactivity in rat models of spinal cord injury, reducing bladder overactivity parameters 4. This suggests the mechanism of pregabalin-induced incontinence in humans may differ from simple bladder overactivity.
Clinical Context and Mechanism
The mechanism likely involves pregabalin's effects on the central nervous system rather than direct bladder effects. Pregabalin causes:
- Somnolence (12-35.7% of patients)
- Dizziness (20.9-32% of patients)
- Cognitive impairment and confusion 1
These CNS effects may impair awareness of bladder fullness or ability to reach toilet facilities in time, contributing to functional incontinence.
Important Clinical Caveats
The incidence is relatively low (1-3% above placebo rates), making this an uncommon but recognized adverse effect. Dose-dependency appears present, with higher rates at 600 mg/day doses 1.
Consider pregabalin as a potential cause when evaluating new-onset urinary incontinence in patients taking this medication, particularly in elderly patients or those on higher doses. One case report demonstrated successful substitution with gabapentin in a patient who developed overflow incontinence on pregabalin, though another case report showed the opposite pattern 5, suggesting individual variation in response.
Do not confuse this with therapeutic use: While pregabalin causes incontinence as an adverse effect, it is being investigated as a potential treatment for overactive bladder in preclinical studies 6, highlighting the complex pharmacology of this agent on bladder function.