What are the key points to counsel a patient with generalized anxiety disorder (GAD) on when switching to pregabalin from their current medications, including venlafaxine (Effexor) XR, buspirone (Buspar), and tramadol (Ultram)?

From the Guidelines

When switching to pregabalin, it is essential to counsel the patient on the risk of respiratory depression when combined with opioids, the risk of respiratory depression when combined with alcohol, and the risk of lower extremity edema. The patient should be informed about the potential risks associated with pregabalin, particularly when combined with other substances.

• The risk of respiratory depression when combined with opioids is a significant concern, as evidenced by a study published in The Lancet Psychiatry 1, which highlights the dangers of combining gabapentinoids with opioids.
• Additionally, the patient should be advised about the risk of respiratory depression when combined with alcohol, as this can exacerbate the sedative effects of pregabalin.
• The risk of lower extremity edema is also a potential side effect of pregabalin, and the patient should be monitored for this condition. It is crucial to prioritize the patient's safety and well-being when switching to pregabalin, and counseling them on these potential risks is essential to ensure their informed consent and cooperation. The patient's medical history, including their current medications and any potential interactions, should be carefully reviewed to minimize the risk of adverse effects. By taking a cautious and informed approach, the patient can be safely transitioned to pregabalin and effectively managed for their generalized anxiety disorder.

From the Research

Key Points to Counsel a Patient with Generalized Anxiety Disorder (GAD) on When Switching to Pregabalin

• Risk of Respiratory Depression: When combined with opioids, such as tramadol, pregabalin may increase the risk of respiratory depression 2, 3.
• Risk of Respiratory Depression with Alcohol: Pregabalin may also increase the risk of respiratory depression when combined with alcohol 2, 3.
• Risk of Lower Extremity Edema: Pregabalin has been associated with lower extremity edema, although the exact mechanism is unclear 3.
• Risk of Increased Anxiety when Starting the Medication: There is no clear evidence to suggest that pregabalin increases anxiety when starting the medication. In fact, studies have shown that pregabalin has a rapid onset of effect, typically within one week, and is effective in reducing anxiety symptoms in patients with GAD 2, 3.
• Other Potential Side Effects: Patients should be counseled on other potential side effects of pregabalin, including dizziness, somnolence, and weight gain 2, 3.
• Importance of Gradual Discontinuation: Patients should be advised to gradually discontinue pregabalin over a period of at least one week to minimize the risk of withdrawal symptoms 2, 3.