Does Lyrica (pregabalin) cause a decrease in gastric and/or generalized bowel motility?

Lyrica (Pregabalin) and Bowel Motility

Yes, Lyrica (pregabalin) can cause decreased gastric and generalized bowel motility, with constipation being a significant adverse effect that can be severe and disabling in some patients. 1

Mechanism and Evidence

• Pregabalin works by binding to α2δ subunits of voltage-dependent calcium channels, which can affect not only neuronal excitability but also smooth muscle function throughout the gastrointestinal tract 2
• In a study of 80 consecutive patients taking pregabalin, 7.5% developed significant constipation within 1-2 weeks of starting the medication 1
• Constipation was the most frequent adverse effect requiring pregabalin discontinuation (6.3% of patients) 1
• The severity of constipation symptoms appears to be dose-dependent, with higher doses more likely to cause significant bowel dysmotility 1

Clinical Significance

• The constipation caused by pregabalin can be severe enough to require drug withdrawal 1
• If not recognized as medication-related, pregabalin-induced constipation can lead to unnecessary diagnostic investigations and procedures 1
• Like other medications that affect gastrointestinal motility, pregabalin may potentially impact the absorption of other concomitantly administered drugs, though specific data for pregabalin is limited 3

Management Considerations

• Patients starting pregabalin should be monitored for signs of decreased bowel motility, particularly during the first 1-2 weeks of treatment 1
• For patients who develop constipation on pregabalin:
  • Consider dose reduction as symptoms appear to be dose-dependent 1
  • Standard constipation management approaches may be tried, including:
    • Ensuring adequate fiber and fluid intake 4
    • Osmotic laxatives (macrogols, lactulose, magnesium salts) 4
    • Stimulant laxatives if osmotic agents are insufficient 4
  • If constipation is severe or disabling, pregabalin discontinuation may be necessary 1

Comparison with Other Medications

• Opioids are well-known to inhibit intestinal motility and cause significant constipation 4
• Anticholinergic medications and some antidepressants can also decrease bowel motility 4
• Calcium channel blockers may contribute to decreased bowel motility 4
• Unlike prokinetic agents (metoclopramide, cisapride, domperidone) that increase gastrointestinal motility, pregabalin has the opposite effect 4

Important Caveats

• The constipation caused by pregabalin is completely reversible upon drug withdrawal 1
• Not all patients will experience this side effect, but clinicians should be vigilant, especially in patients with pre-existing bowel motility issues 1
• Patients with a history of severe constipation may need closer monitoring when starting pregabalin therapy 1

Clinical Pearls

• When evaluating new or worsening constipation in a patient, always consider medication effects, including recently initiated pregabalin 1
• The onset of pregabalin-induced constipation typically occurs within 1-2 weeks of starting the medication 1
• Despite its potential to cause constipation, pregabalin may have benefits in certain patient populations, such as helping reduce benzodiazepine use in psychiatric patients 5