Pregabalin and GERD: Association and Clinical Implications
Pregabalin (Lyrica) is not known to cause gastroesophageal reflux disease (GERD) based on current clinical evidence and guidelines.
Understanding GERD and Medication Associations
GERD is a common condition characterized by the reflux of gastric contents into the esophagus, causing symptoms such as heartburn and regurgitation. While certain medications are known risk factors for GERD development or exacerbation, pregabalin is not among them.
Known Medication Risk Factors for GERD:
According to systematic reviews, medications that can cause or worsen GERD typically fall into these categories 1:
- Medications that directly damage esophageal mucosa
- Medications that reduce lower esophageal sphincter pressure (LESP)
- Medications that affect esophagogastric motility
Common medications associated with GERD include:
- NSAIDs
- Acetylsalicylic acid
- Calcium channel blockers
- Nitrates
- Some antidepressants
- Benzodiazepines
- Anticholinergics
- Theophylline
Pregabalin's Role in GI Function
Pregabalin is a gabapentinoid that acts as a central neuromodulator. Rather than causing GERD, recent evidence suggests pregabalin may actually have beneficial effects on certain gastrointestinal conditions:
- A 2021 randomized clinical trial showed pregabalin improved symptoms in functional dyspepsia patients, with significant alleviation of epigastric pain 2
- Pregabalin has been studied as a potential treatment for visceral hypersensitivity, which can be present in some gastrointestinal disorders 2
GERD Management Considerations
The American Gastroenterological Association (AGA) clinical practice update on GERD management does not list pregabalin as a cause of GERD or as a medication that exacerbates GERD symptoms 3. Instead, the AGA discusses GABA-B agonists like baclofen (not pregabalin, which is not a GABA-B agonist) as potential adjunctive therapy for GERD in specific circumstances 3.
Therapeutic Options for GERD:
According to current guidelines, GERD management includes 3:
- Lifestyle modifications
- PPI therapy (cornerstone of treatment)
- Adjunctive therapies:
- H2 receptor antagonists
- Alginates
- Prokinetics (limited evidence)
- Baclofen (for specific indications like belching or regurgitation)
Clinical Implications
If a patient taking pregabalin develops GERD symptoms:
- Consider other common causes of GERD
- Evaluate for other medications the patient may be taking that are known GERD triggers
- Implement standard GERD management approaches
- Do not assume pregabalin is the cause, as there is no established association
Conclusion
While medication-induced GERD is a recognized clinical entity, pregabalin has not been identified as a causative agent in current gastroenterological literature or guidelines. In fact, pregabalin may have beneficial effects on certain gastrointestinal symptoms through its neuromodulatory properties. Patients experiencing GERD symptoms while taking pregabalin should be evaluated for other potential causes and managed according to standard GERD treatment guidelines.