What are the side effects of Lyrica (pregabalin)?

Side Effects of Lyrica (Pregabalin)

Lyrica (pregabalin) commonly causes dizziness, somnolence, peripheral edema, weight gain, blurred vision, dry mouth, and cognitive dysfunction as its most frequent side effects. 1

Common Side Effects

Pregabalin's FDA label identifies several common adverse effects that occur in a significant percentage of patients:

• Neurological effects:

  • Dizziness (up to 38%)
  • Somnolence/drowsiness (up to 28%)
  • Ataxia (up to 20%)
  • Confusion (up to 7%)
  • Incoordination (up to 6%)
  • Thinking abnormalities (up to 9%)
  • Tremor (up to 11%)

• Visual disturbances:

  • Blurred vision (up to 12%)
  • Diplopia/double vision (up to 12%)
  • Abnormal vision (up to 5%)

• Metabolic effects:

  • Weight gain (up to 16%)
  • Peripheral edema (up to 9%)
  • Increased appetite (up to 6%)

• Gastrointestinal effects:

  • Dry mouth (up to 6%)
  • Constipation (up to 7%)

Serious Side Effects

While less common, pregabalin can cause several serious adverse effects that require monitoring:

• Allergic reactions: Potentially life-threatening allergic reactions including swelling of the face, mouth, lips, gums, tongue, throat or neck, rash, hives, and breathing difficulties 1

• Suicidal thoughts or actions: Like other antiepileptic drugs, pregabalin may increase the risk of suicidal thoughts or behavior in approximately 1 in 500 people 1

• Serious breathing problems: Especially when combined with opioid medications or in patients with pre-existing respiratory conditions 1

• Muscle problems: Including muscle pain, soreness, or weakness, particularly when accompanied by fever 1

• Visual field defects: Cases of visual field restriction have been reported in clinical trials 2

Special Populations and Considerations

Elderly Patients

Older adults may be more sensitive to side effects, particularly:

• Dizziness and falls
• Cognitive effects
• Peripheral edema
• Weight gain 1, 2

Patients with Renal Impairment

• Pregabalin is eliminated primarily through renal excretion
• Dose adjustment is required for patients with creatinine clearance below 60 ml/min 2
• Failure to adjust dosing in renal impairment can lead to increased side effects

Drug Interactions

• CNS depressants: Increased risk of sedation, dizziness, and respiratory depression when combined with:

  • Opioid pain medications
  • Benzodiazepines
  • Alcohol
  • Other sedating medications 1

• ACE inhibitors: Potential for increased risk of angioedema 1

• Thiazolidinediones (Avandia, Actos): May increase risk of peripheral edema and weight gain 1

Withdrawal Considerations

Abrupt discontinuation of pregabalin can lead to withdrawal symptoms including:

• Headaches
• Nausea
• Diarrhea
• Insomnia
• Increased sweating
• Anxiety 1

Pregabalin should be tapered gradually over at least one week to minimize withdrawal symptoms 1, 3.

Monitoring Recommendations

• Regular assessment for emergence or worsening of depression, suicidal thoughts or behavior 1
• Weight monitoring due to potential for significant weight gain 1, 4
• Monitoring for peripheral edema, particularly in patients with cardiovascular conditions or taking other medications that may cause fluid retention 1, 2
• Visual examinations if patients report changes in vision 1

Comparison to Similar Medications

Pregabalin has a similar side effect profile to gabapentin, but may have some advantages:

• More predictable absorption
• Linear pharmacokinetics
• Higher bioavailability (approximately 90%) 5
• May be more effective at reducing benzodiazepine use in psychiatric patients compared to gabapentin 3

However, both medications share common side effects including dizziness, somnolence, peripheral edema, and weight gain 6, 2.