Is Lyrica a Controlled Medication?
Yes, Lyrica (pregabalin) is a Schedule V controlled substance in the United States, which is the lowest classification for controlled substances with recognized medical use and limited potential for abuse or dependence. 1
Regulatory Classification
- The FDA officially designates pregabalin as a Schedule V controlled substance due to its potential for misuse or abuse, including development of tolerance, dose escalation, and drug-seeking behavior 1
- This classification places pregabalin in the same category as other medications with low but recognized abuse potential 2
Evidence of Abuse Potential
- In recreational drug users, pregabalin 450 mg produced subjective ratings of "good drug effect," "high," and "liking" similar to diazepam 30 mg 1
- In controlled clinical trials of over 5,500 patients, 4% of pregabalin-treated patients reported euphoria as an adverse reaction (compared to 1% on placebo), with rates ranging from 1-12% in certain patient populations 1
- Among patients with opiate dependency syndrome, 12.1% tested positive for pregabalin without medical indication, suggesting significant abuse potential in this vulnerable population 3
Physical Dependence Characteristics
- Abrupt or rapid discontinuation of pregabalin can cause withdrawal symptoms including insomnia, nausea, headache, diarrhea, anxiety, and hyperhidrosis 1
- These symptoms are consistent with physical dependence that develops during chronic use 1
High-Risk Populations Requiring Vigilance
- Patients with current or past opiate addiction show significantly higher rates of pregabalin abuse (12.1% vs 2.7% in control populations) 3
- Male patients and those prescribed antipsychotics or benzodiazepines have increased risk of using pregabalin above recommended dosages 4
- Approximately 9.6% of pregabalin users receive doses exceeding 600 mg/day for 6 months or longer, which exceeds the maximum recommended therapeutic dose 4
Clinical Implications for Prescribing
- Carefully evaluate all patients for history of drug abuse before prescribing pregabalin 1
- Monitor patients for signs of misuse including dose escalation, early refill requests, obtaining prescriptions from multiple providers, and drug-seeking behavior 1, 5
- Exercise particular caution when prescribing to patients with opiate dependency syndrome, as this population demonstrates substantially higher abuse rates 3
- The Schedule V classification means pregabalin prescriptions are subject to controlled substance regulations, though less restrictive than Schedule II-IV medications 2