Can Lyrica (pregabalin) cause forgetfulness?

Pregabalin (Lyrica) and Forgetfulness

Yes, pregabalin (Lyrica) can cause forgetfulness and cognitive impairment as documented in the FDA drug label and supported by research studies.

Evidence from FDA Drug Label

The FDA drug label for pregabalin explicitly lists cognitive side effects including:

• Thinking abnormal (difficulty with concentration/attention)
• Confusion
• Memory impairment
• Amnesia

These cognitive side effects occur in a dose-dependent manner, with higher incidence at higher doses 1. In controlled trials for various conditions, memory impairment was reported in 3-5% of patients taking pregabalin compared to 0-2% in placebo groups 1.

Research Evidence on Cognitive Effects

Multiple studies have confirmed pregabalin's negative impact on cognition:

• A double-blind, placebo-controlled trial in healthy volunteers showed that pregabalin at 600 mg/day caused significant negative effects on cognitive function after 12 weeks of treatment, affecting performance on tests of attention, processing speed, and verbal fluency 2.

• A 2017 study demonstrated that daily administration of pregabalin (30 mg/kg) in an animal model significantly impaired memory as measured by object recognition tests 3.

Mechanism and Risk Factors

Pregabalin's cognitive side effects likely stem from its mechanism of action:

• It binds to α2δ subunits of voltage-gated calcium channels in the central nervous system
• This reduces the release of excitatory neurotransmitters involved in cognitive processing
• The sedative effects contribute to cognitive impairment

Risk factors for increased cognitive impairment include:

• Higher doses (cognitive effects are dose-dependent)
• Older age
• Renal impairment (pregabalin is primarily eliminated by renal excretion)
• Concurrent use of other CNS depressants

Management Recommendations

If a patient experiences forgetfulness while taking pregabalin:

1. Dose adjustment: Consider lowering the dose if clinically appropriate, as cognitive effects are dose-dependent 1.

2. Timing of administration: Taking the medication at bedtime may minimize daytime cognitive impairment.

3. Monitoring: Regularly assess cognitive function, especially in older adults or those with pre-existing cognitive concerns.

4. Alternative medications: Consider alternative treatments if cognitive side effects significantly impact quality of life.

5. Gradual discontinuation: If pregabalin needs to be discontinued, taper gradually to avoid withdrawal symptoms.

Clinical Considerations

• Cognitive effects may be more pronounced at treatment initiation and may partially improve with continued use.

• Patients should be warned about potential cognitive effects and advised to avoid activities requiring mental alertness until their response to the medication is known.

• Healthcare providers should document baseline cognitive function before starting pregabalin to better assess any changes.

• The risk of cognitive impairment must be balanced against the therapeutic benefits for pain, anxiety, or seizure control.

Pregabalin is listed among medications associated with weight gain in patients with diabetes, along with other anticonvulsants like gabapentin 4, which suggests these medications share similar side effect profiles.