Pregabalin (Lyrica) Effects on Gastric Motility

Yes, pregabalin (Lyrica) can cause decreased gastric motility, which may lead to severe constipation in some patients. 1, 2

Mechanism and Effects

Pregabalin has been documented to reduce gastrointestinal motility, with constipation being a significant adverse effect that can develop within 1-2 weeks of starting treatment 2
The severity of constipation symptoms appears to be dose-dependent, with higher doses more likely to cause more severe motility disturbances 2
In some cases, pregabalin-induced constipation can be severe enough to require discontinuation of the medication (affecting approximately 6.3% of patients in one study) 2

Pregabalin's effects on gastrointestinal motility are similar to those seen with other classes of medications including:
- Opioids, which significantly delay gastric emptying 1, 3
- Anticholinergic medications, which reduce bowel motility 1, 4
- Tricyclic antidepressants, which have anticholinergic properties that can decrease intestinal motility 4, 1
- Calcium channel blockers, which may contribute to decreased bowel motility 1
In contrast, prokinetic agents like metoclopramide, cisapride, and domperidone increase gastrointestinal motility, having the opposite effect of pregabalin 1, 3

Pregabalin-induced constipation can lead to unnecessary medical investigations and procedures if not recognized as a medication side effect 2
The effect is reversible upon discontinuation of pregabalin 2
Unlike some medications that primarily affect gastric emptying rate, pregabalin may have broader effects on intestinal motility 2, 1
A pilot study examining pregabalin's effects on colonic functions in irritable bowel syndrome patients found no significant effect on colonic compliance, sensation thresholds, or motility index, suggesting its effects may vary throughout different segments of the gastrointestinal tract 5

Ensuring adequate fiber and fluid intake can help manage constipation in patients taking pregabalin 1
Osmotic laxatives (macrogols, lactulose, magnesium salts) may be necessary to counteract the decreased motility 1
If constipation persists despite these measures, stimulant laxatives may be added 1
In cases of severe constipation that doesn't respond to these interventions, consideration should be given to reducing the dose or discontinuing pregabalin 2

Patients starting pregabalin should be monitored for changes in bowel habits, particularly within the first 1-2 weeks of treatment 2
Patients with pre-existing constipation or motility disorders may be at higher risk and should be monitored more closely 1, 2
If severe constipation develops, consider dose reduction or medication discontinuation rather than adding multiple laxatives 2