Can Pregabalin Cause Angioedema?
Yes, pregabalin can cause angioedema, including life-threatening cases with respiratory compromise that require immediate discontinuation of the medication. 1
FDA-Recognized Risk
The FDA drug label explicitly warns that postmarketing reports have documented angioedema in patients during both initial and chronic pregabalin treatment 1. Specific manifestations include:
- Swelling of the face, mouth (tongue, lips, and gums), and neck (throat and larynx) 1
- Life-threatening angioedema with respiratory compromise requiring emergency treatment 1
- Cases occurring during both initial therapy and long-term use 1
Clinical Management
Pregabalin must be discontinued immediately if angioedema symptoms develop 1. The FDA label provides clear guidance:
- Exercise caution when prescribing pregabalin to patients with a previous episode of angioedema from any cause 1
- Patients taking other drugs associated with angioedema (particularly ACE inhibitors) may be at increased risk 1
- This represents a contraindication requiring permanent cessation, not dose adjustment 1
Context Within Pregabalin's Adverse Effect Profile
While angioedema is a serious but less common adverse effect, pregabalin's more frequent side effects include 2:
- Dizziness (23-46% of patients) 3
- Somnolence (15-25% of patients) 3
- Peripheral edema (approximately 10%, dose-dependent) 2, 3
- Weight gain 2, 3
- Headache 2
Important Clinical Caveat
The peripheral edema commonly seen with pregabalin (10% of patients) is distinct from angioedema 2. Peripheral edema is dose-dependent and typically involves dependent areas, whereas angioedema is asymmetric, non-dependent swelling affecting deeper tissue layers, particularly the face, mouth, and airway 2. Do not confuse routine pregabalin-associated peripheral edema with the emergency presentation of angioedema.
Related Medication Consideration
Gabapentin, a structurally related medication, has also been reported to cause angioedema in case reports, suggesting this may be a class effect of calcium channel α2-δ ligands 4.