Lyrica (Pregabalin) Side Effects
The most common side effects of Lyrica (pregabalin) include dizziness, somnolence, peripheral edema, weight gain, blurred vision, dry mouth, and headache, with dizziness occurring in up to 46% of patients and somnolence in up to 25% of patients at higher doses. 1, 2
Common Side Effects
Central Nervous System Effects
- Dizziness: Occurs in 27-46% of patients at 600 mg/day 2, 1
- Somnolence/drowsiness: Affects 15-25% of patients at 600 mg/day 2, 1
- Confusion: More common in elderly patients 2
- Ataxia: Difficulty with coordination and balance 1
- Euphoria: Feeling "high" 1
- Abnormal thinking: Difficulty with concentration/attention 1
- Tremor: Involuntary shaking 1
- Incoordination: Difficulty with fine motor skills 1
Visual Disturbances
- Blurred vision: Occurs in 5-12% of patients 1
- Diplopia (double vision): More common at higher doses 1
- Abnormal vision: Visual disturbances when newly started 2
Gastrointestinal Effects
- Dry mouth: Common side effect 1
- Constipation: Occurs in 1-7% of patients 1
- Increased appetite: Leading to weight gain 1
Metabolic Effects
- Weight gain: Dose-dependent, occurring in up to 16% of patients 1, 2
- Peripheral edema: Swelling of hands and feet 1, 2
Serious Side Effects
Allergic Reactions
- Angioedema: Swelling of face, mouth, lips, gums, tongue, throat, or neck 1
- Rash, hives, or blisters: Signs of serious allergic reaction 1
- Breathing difficulties: Potentially life-threatening 1
Psychiatric Effects
- Suicidal thoughts or actions: Like other antiepileptic drugs, pregabalin may increase risk of suicidal thoughts in a small number of people (about 1 in 500) 1
- Depression: New or worsening 1
- Anxiety: New or worsening 1
Respiratory Effects
- Serious breathing problems: Especially when taken with other medications that cause sleepiness or with pre-existing respiratory conditions 1
Side Effects Requiring Monitoring
Cardiovascular
- Edema: Swelling that can be a serious problem for people with heart problems 1
Neurological
- Muscle problems: Muscle pain, soreness, or weakness, especially with fever 1
Special Populations
Elderly Patients
- More susceptible to side effects, particularly:
- Should start with lower doses and titrate more slowly 3
Patients with Renal Impairment
- Higher risk of drug accumulation and toxicity 2, 3
- Dose adjustment required based on creatinine clearance 3
- Life-threatening toxicity possible without appropriate dose reduction 2
Women of Reproductive Potential
Drug Interactions
- Opioid pain medications: Increased risk of dizziness, sleepiness, and serious breathing problems 1
- Anxiety medications (like lorazepam): Enhanced sedative effects 1
- Sleep medications (like zolpidem): Enhanced sedative effects 1
- ACE inhibitors: Higher chance for swelling and hives 1
- Thiazolidinediones (rosiglitazone, pioglitazone): Increased risk of weight gain and edema 1
Discontinuation Effects
Abrupt discontinuation may cause:
- Headaches
- Nausea
- Diarrhea
- Trouble sleeping
- Increased sweating
- Anxiety
- Seizures (in patients with epilepsy) 1
Monitoring Recommendations
- Regular assessment for side effects, especially at initiation and dose increases
- Weight monitoring due to potential for significant weight gain
- Renal function should be assessed before starting and periodically during treatment
- Mental health status should be monitored for signs of depression, anxiety, or suicidal thoughts
- Visual changes should be reported promptly to healthcare provider 1, 3
Risk Mitigation
- Start with lower doses in elderly patients and those with renal impairment 3
- Avoid alcohol while taking pregabalin as it can increase side effects like sleepiness and dizziness 1
- Do not drive or operate machinery until effects on alertness and coordination are known 1
- Taper gradually when discontinuing to minimize withdrawal effects 1
Understanding these side effects is crucial for patients taking Lyrica to recognize potential problems early and discuss them with their healthcare provider.