Does pregabalin (lyrica) cause hair loss?

Pregabalin and Hair Loss

Pregabalin has been reported to cause hair loss, though it is a relatively rare side effect occurring in a small number of patients. 1

Evidence on Pregabalin-Induced Hair Loss

Incidence and Documentation

• Pregabalin has been documented to cause alopecia, though at a much lower rate than other antiseizure medications like valproate, lamotrigine, and carbamazepine 1
• According to the most recent comprehensive review of antiseizure medication-induced alopecia (2023), only 4 cases of pregabalin-induced hair loss have been formally reported in the literature 1
• This places pregabalin among the lower-risk medications for this side effect compared to valproate (983 reported cases) or lamotrigine (355 reported cases)

Mechanism and Characteristics

• When pregabalin does cause hair loss, it typically presents as:
  • Diffuse, non-scarring alopecia
  • Telogen effluvium (premature resting phase of hair follicles)
  • Reversible upon dose reduction or discontinuation 1

Risk Factors

• Individual susceptibility plays a significant role in drug-induced hair loss 2, 3
• The prevalence and severity depend on both the specific medication and individual predisposition 3
• Higher doses may increase the risk, as some drug-induced alopecia shows dose-dependent relationships (as seen with valproate) 4

Management Considerations

Monitoring and Assessment

• Hair loss may not be spontaneously reported by patients but can significantly impact quality of life and medication adherence 4
• If a patient on pregabalin reports hair loss, consider:
  • Timing of hair loss in relation to medication initiation
  • Pattern and extent of hair loss
  • Ruling out other causes of alopecia

Interventions

• If pregabalin-induced hair loss is suspected:
  1. Consider dose reduction if clinically appropriate 1
  2. If severe or distressing to the patient, consider switching to an alternative medication with lower risk of alopecia
  3. Reassure the patient that the hair loss is typically reversible upon dose adjustment or discontinuation 1, 5

Clinical Perspective

While hair loss is listed among potential side effects of several anticonvulsants including pregabalin, it's important to note that:

• The risk appears substantially lower with pregabalin than with valproate or lamotrigine
• Most cases resolve with dose adjustment or discontinuation
• The benefit of pregabalin for neuropathic pain or seizure control must be weighed against this potential cosmetic side effect

When treating neuropathic pain, pregabalin remains a first-line option with proven efficacy 6, and the rare occurrence of hair loss should not necessarily preclude its use unless the patient has particular concerns about this side effect.