Does Lyrica (pregabalin) cause hair loss?

Does Lyrica (Pregabalin) Cause Hair Loss?

Lyrica (pregabalin) is not typically associated with hair loss as a common side effect, though individual reactions may vary.

Understanding Drug-Induced Hair Loss

Drug-induced hair loss generally occurs through several mechanisms:

1. Telogen effluvium: Premature shifting of hairs from growth phase to resting phase
2. Anagen effluvium: Direct toxic effect on actively growing hair follicles
3. Accentuation of androgenetic alopecia: Through hormonal mechanisms

Known Medications Associated with Hair Loss

Several medications have established connections to hair loss:

• Mood stabilizers: Lithium (12-19% of long-term users), valproic acid (up to 12% of patients, dose-dependent), and carbamazepine (<6% of users) 1, 2
• Chemotherapy agents: Approximately 48% of chemotherapy treatments result in grade 2 alopecia (>50% hair loss) 3
• Endocrine therapies: Aromatase inhibitors (22.4% reported hair loss, 31.8% reported thinning) 3

Pregabalin and Hair Loss

Pregabalin (Lyrica) is not specifically mentioned in any of the guidelines or research evidence provided as a medication known to cause hair loss. The most comprehensive lists of medications associated with alopecia do not include pregabalin among common culprits.

Differential Diagnosis for Hair Loss

If a patient taking Lyrica experiences hair loss, consider these alternative causes:

• Alopecia areata: An autoimmune condition causing patchy hair loss 3
• Telogen effluvium: Can be triggered by fever, hemorrhage, severe illness, stress, and childbirth 4
• Trichotillomania: Compulsive hair pulling that can be confused with other forms of hair loss 3
• Tinea capitis: Fungal infection of the scalp 3
• Systemic conditions: Thyroid disorders, iron deficiency, or other autoimmune diseases 3

Clinical Approach to Suspected Drug-Induced Hair Loss

When evaluating hair loss in a patient taking Lyrica:

1. Establish timeline: Determine if hair loss began after starting the medication
2. Rule out confounders: Exclude other triggers of telogen effluvium
3. Examine pattern of hair loss: Drug-induced hair loss is typically diffuse rather than patchy
4. Consider investigations when diagnosis is uncertain:
   • Skin biopsy
   • Thyroid function tests
   • Iron studies
   • Autoimmune markers if indicated

Management Considerations

If hair loss occurs in a patient on Lyrica with no other identifiable cause:

• Reassurance: Drug-induced hair loss is usually reversible upon discontinuation 5
• Risk-benefit assessment: Weigh the therapeutic benefit of Lyrica against the cosmetic concern
• Consider alternatives: If hair loss is significantly impacting quality of life and Lyrica is the suspected cause, discuss alternative medications with similar therapeutic effects

Key Points

• Hair loss is not listed among common side effects of pregabalin
• When hair loss occurs in patients taking medications, a thorough evaluation is needed before attributing it to the drug
• Most drug-induced hair loss resolves after discontinuation of the causative agent
• Documentation of temporal relationship between drug initiation and onset of hair loss is important for establishing causality