Managing Dizziness with Pregabalin (Lyrica)
If you experience dizziness while taking Lyrica (pregabalin), do not stop the medication abruptly but instead contact your healthcare provider to discuss dose adjustment or gradual tapering, as dizziness is a common side effect that often improves with time.
Understanding Dizziness with Pregabalin
Dizziness is one of the most common side effects of pregabalin, affecting approximately 30% of patients taking the medication compared to 8% of those on placebo 1. This side effect typically:
- Begins shortly after starting pregabalin therapy
- Occurs more frequently at higher doses
- May persist until the last dose in about 30% of affected patients
Risk Factors for Dizziness
Several factors increase the risk of experiencing dizziness with pregabalin:
- Age ≥65 years (2.5 times higher risk) 2
- Concomitant use of strong opioids (5.5 times higher risk) 2
- Higher initial doses of pregabalin
- Impaired renal function (requires dose adjustment)
Management Algorithm for Pregabalin-Related Dizziness
Step 1: Assess Severity and Impact
- Mild dizziness that doesn't interfere with daily activities: Continue medication with precautions
- Moderate to severe dizziness affecting function: Proceed to dose adjustment
Step 2: Dose Adjustment Options
Temporary dose reduction:
- Reduce to the lowest effective dose that minimizes dizziness
- For example, if taking 150 mg twice daily, consider reducing to 75 mg twice daily
Change dosing schedule:
- Split the total daily dose into three smaller doses instead of two
- Take a larger portion of the daily dose at bedtime to reduce daytime symptoms
Gradual titration:
- Start with a lower dose (e.g., 25-50 mg/day)
- Increase gradually over 1-2 weeks to reach therapeutic dose
Step 3: Lifestyle Modifications
- Avoid alcohol and other CNS depressants
- Rise slowly from sitting or lying positions
- Avoid driving or operating machinery until dizziness resolves
- Ensure adequate hydration
Step 4: Consider Alternative Options
If dizziness persists despite adjustments:
- Discuss alternative medications for your condition with your healthcare provider
- Consider gabapentin as an alternative (though it may also cause dizziness)
Important Warnings and Precautions
- Never stop pregabalin abruptly: This can lead to withdrawal symptoms including insomnia, nausea, headache, anxiety, hyperhidrosis, and diarrhea 1
- Proper tapering: If discontinuation is necessary, taper gradually over at least 1 week 1
- Monitor for other side effects: Watch for somnolence, peripheral edema, and weight gain 1
- Special caution with CNS depressants: Concomitant use with opioids or other CNS depressants increases risk of dizziness and respiratory depression 1
When to Contact Healthcare Provider Immediately
Seek immediate medical attention if dizziness is accompanied by:
- Severe allergic reactions (swelling of face, mouth, lips, gums, tongue, throat or neck)
- Trouble breathing
- Rash or hives
- Significant changes in mood or thoughts of self-harm
- Significant impairment in daily functioning
Pregabalin is an effective medication for neuropathic pain, epilepsy, and anxiety disorders, but proper management of side effects is essential for successful treatment. With appropriate dose adjustments and precautions, many patients can continue to benefit from pregabalin despite initial dizziness.