Is pregabalin (Lyrica) associated with dizziness?

From the Guidelines

Pregabalin (Lyrica) is associated with dizziness, with dose-dependent dizziness and sedation being common side effects, as reported in the 2010 study published in the Mayo Clinic Proceedings 1.

Mechanism and Side Effects

The medication works by binding to voltage-gated calcium channels at the a-d subunit and inhibiting neurotransmitter release, which can lead to dizziness and sedation in some patients.

• Dizziness typically occurs when starting the medication or increasing the dose, as the body adjusts to the drug's effects on the nervous system.
• The study notes that both gabapentin and pregabalin can produce dose-dependent dizziness and sedation, which can be reduced by starting with lower dosages and titrating cautiously 1.

Management of Dizziness

If experiencing dizziness while taking Lyrica, it is recommended to:

• Contact a healthcare provider, who may recommend taking the medication at bedtime, starting with a lower dose and gradually increasing it, dividing the daily dose into smaller amounts taken throughout the day, or ensuring position changes are made slowly.
• Stay hydrated and avoid alcohol to minimize dizziness.
• In most cases, this side effect diminishes over time as the body adapts to the medication, typically within a few weeks.
• If dizziness is severe or persistent, the doctor might consider adjusting the dose or switching to an alternative medication, as suggested by the guidelines for the pharmacological management of neuropathic pain 1.

From the FDA Drug Label

Pregabalin may cause dizziness and somnolence. Inform patients that pregabalin-related dizziness and somnolence may impair their ability to perform tasks such as driving or operating machinery [see PATIENT COUNSELING INFORMATION (17)] In the pregabalin controlled trials in adult patients, dizziness was experienced by 30% of pregabalin-treated patients compared to 8% of placebo-treated patients;

Pregabalin is associated with dizziness. The incidence of dizziness in pregabalin-treated patients was 30%, compared to 8% in placebo-treated patients 2.

From the Research

Pregabalin and Dizziness

• Pregabalin, also known as Lyrica, is associated with dizziness as a common adverse event, as reported in several studies 3, 4, 5, 6.
• The study published in 2019 found that dizziness was more common with pregabalin than with placebo, with incidence rates of 29% and 35% for 300 mg and 600 mg daily doses, respectively 3.
• Another study published in 2014 noted that dizziness is a common adverse event associated with pregabalin treatment, along with somnolence and weight gain 4.
• A 2009 study modeled the dizziness, drowsiness, and dropout associated with pregabalin use in generalized anxiety disorder, and found that daily titrated dose was a predictor for the time to first non-zero dizziness or drowsiness score 5.
• A 2007 review of pregabalin's pharmacology and clinical efficacy also reported dizziness and somnolence as the most common adverse events 6.
• Additionally, a 2011 case report highlighted the potential for pregabalin to cause peripheral and central edema, which may be related to its mechanism of action and could contribute to dizziness 7.

Incidence of Dizziness

• The incidence of dizziness varied across studies, but was generally higher with pregabalin than with placebo, with rates ranging from 13% to 35% 3, 4, 6.
• The study published in 2019 found that the incidence of dizziness was dose-dependent, with higher rates at higher doses of pregabalin 3.
• The 2014 study noted that dizziness was a common adverse event, but did not provide specific incidence rates 4.

Mechanism of Dizziness

• The exact mechanism of pregabalin-induced dizziness is not fully understood, but may be related to its effects on calcium channels and neurotransmission 6, 7.
• The 2011 case report suggested that pregabalin's mechanism of action may contribute to peripheral and central edema, which could contribute to dizziness 7.