Can You Take Pregabalin and Methylcobalamin Together?
Yes, you can safely take pregabalin and methylcobalamin together—this combination is not only safe but may provide enhanced therapeutic benefit for neuropathic pain compared to pregabalin alone. 1, 2
Evidence Supporting Combined Use
The combination of pregabalin and methylcobalamin has been specifically studied and shown to be effective:
A real-world study of fixed-dose combination (75-150 mg sustained-release pregabalin with 1500 mcg methylcobalamin) demonstrated 72.3% reduction in pain scores over 14 days, with significant improvement in both positive and negative neuropathic symptoms 1
The combination was well-tolerated with >95% of investigators and patients rating efficacy and tolerability as good to excellent 1
Research comparing pregabalin/methylcobalamin/alpha-lipoic acid combination versus pregabalin alone showed the combination improved nerve conduction velocity in diabetic peripheral neuropathy, suggesting potential disease-modifying effects beyond pain relief 2
A study on chronic postthoracotomy pain found that pregabalin-methylcobalamin combination resulted in 88% of patients achieving pain scores <5/10, compared to only 36% with diclofenac alone 3
Safety Profile
The combination demonstrates a favorable safety profile:
Most common adverse effects are mild: giddiness (4.7%), sedation (3.6%), dizziness (2.9%), drowsiness (2.3%), and nausea (2.3%) 1
These side effects are primarily attributable to pregabalin itself, as methylcobalamin (vitamin B12) has minimal adverse effects 1, 3
Minor adverse events occurred in 28% of patients but did not require treatment discontinuation 3
Important Considerations
When using pregabalin, regardless of combination with methylcobalamin:
Start with low doses (50-75 mg twice or three times daily) and titrate gradually to minimize dizziness and sedation 4
Reduce doses in renal impairment, as pregabalin is eliminated unchanged through the kidneys 4
Maximum dose is 600 mg/day (200 mg three times daily or 300 mg twice daily) 4
Do not discontinue abruptly—taper gradually to avoid withdrawal symptoms 5
One notable caveat: Pregabalin itself can reduce vitamin B12 levels, which is listed as a risk factor for B12 deficiency 4. This actually provides additional rationale for combining pregabalin with methylcobalamin supplementation, as the methylcobalamin may help counteract this potential depletion.
No Drug Interactions
There are no significant pharmacokinetic or pharmacodynamic interactions between pregabalin and methylcobalamin:
Pregabalin has few drug interactions overall 4
Methylcobalamin (vitamin B12) does not interact with pregabalin's mechanism of action at calcium channels 1
The combination allows for potentially lower effective doses of pregabalin (as low as 50% of typical monotherapy doses) while maintaining efficacy 6