Can Lyrica (pregabalin) cause sexual side effects in a patient with a history of substance abuse and respiratory disease, who is currently taking buprenorphine?

Does Lyrica Cause Sexual Side Effects?

Yes, Lyrica (pregabalin) can cause sexual side effects, including anorgasmia (inability to achieve orgasm), impotence, and abnormal ejaculation, as documented in the FDA prescribing information. 1

Sexual Side Effects Profile of Pregabalin

The FDA-approved drug label for pregabalin explicitly lists several sexual dysfunctions as adverse reactions observed during clinical trials 1:

Documented Sexual Adverse Effects

Frequent sexual side effects (occurring in ≥1/100 patients):

• Anorgasmia (inability to reach orgasm)
• Impotence (erectile dysfunction)
• Urinary incontinence 1

Infrequent sexual side effects (occurring in 1/100 to 1/1000 patients):

• Abnormal ejaculation
• Amenorrhea (absence of menstruation)
• Dysmenorrhea (painful menstruation)
• Leukorrhea (vaginal discharge)
• Menorrhagia (heavy menstrual bleeding)
• Metrorrhagia (irregular menstrual bleeding) 1

Postmarketing reports include:

• Gynecomastia (breast enlargement in males)
• Breast enlargement 1

Special Considerations for Patients on Buprenorphine

Compounding Sexual Dysfunction Risk

Your patient faces a particularly high risk for sexual dysfunction due to the combination of buprenorphine maintenance therapy and potential pregabalin use. The evidence demonstrates that buprenorphine itself causes substantial sexual side effects 2, 3, 4:

• 83-90% of men on buprenorphine maintenance therapy report at least one sexual dysfunction symptom 2, 3
• Common dysfunctions include premature ejaculation (83%), erectile dysfunction (43%), and reduced sexual desire (33%) 3
• A 2020 study using validated instruments (IIEF-5) confirmed significantly higher erectile dysfunction severity in buprenorphine/naloxone patients compared to controls (p=0.001) 4

Abuse Potential in Substance Use Disorder Patients

Pregabalin carries significant abuse potential, particularly in patients with opioid use disorder receiving buprenorphine maintenance therapy. 5, 6

• Pregabalin is frequently co-abused with buprenorphine (32.5% of pregabalin abusers also used buprenorphine) 5
• Patients in opioid substitution treatment are at substantially higher risk for pregabalin abuse (41.2% vs 21.7%, p<0.001) 5
• The majority of pregabalin abuse cases involve patients with a history of substance abuse, especially opiate abusers 6
• Pregabalin produces euphoric and dissociative effects when taken in supratherapeutic doses 6

Respiratory Depression Risk

The combination of pregabalin with buprenorphine poses life-threatening respiratory depression risk. 1

• The FDA label includes postmarketing reports of life-threatening or fatal respiratory depression when pregabalin is combined with opioids (including buprenorphine) or other CNS depressants 1
• This risk is amplified in patients with underlying respiratory disease, as mentioned in your patient's history 1

Clinical Recommendations

If pregabalin must be prescribed to this patient:

• Directly counsel the patient about expected sexual side effects (anorgasmia, impotence, abnormal ejaculation) before initiating therapy 1
• Monitor closely for signs of pregabalin abuse, including requests for dose escalation, early refills, or reports of euphoria 5, 6
• Assess respiratory function regularly given the combined respiratory depression risk with buprenorphine and underlying respiratory disease 1
• Consider alternative medications with lower abuse potential and fewer sexual side effects, particularly given the patient's substance abuse history 5, 6
• Address sexual dysfunction proactively, as noncommunication about sexual problems correlates with worse outcomes and may impact treatment adherence 4

Important Caveat

Sexual dysfunction from pregabalin may be difficult to distinguish from buprenorphine-induced sexual dysfunction, as both medications independently cause similar sexual side effects 1, 3, 4. If sexual dysfunction worsens after starting pregabalin, consider dose reduction or discontinuation of pregabalin first, as buprenorphine maintenance should generally be continued for opioid use disorder treatment 7.