Can Lyrica Be Taken the Day Before CABG?
Yes, Lyrica (pregabalin) can be safely taken the day before CABG surgery and does not require discontinuation in the preoperative period.
Key Evidence
Pregabalin is not listed among medications requiring preoperative discontinuation before CABG in major cardiac surgery guidelines. The comprehensive perioperative medication management protocols from the American Heart Association and American College of Cardiology specify which drugs must be stopped before CABG, and pregabalin is notably absent from these lists 1, 2, 3.
Medications That DO Require Discontinuation Before CABG
The following agents must be stopped preoperatively due to bleeding risk:
Antiplatelet Agents
- Clopidogrel and ticagrelor: Discontinue at least 5 days before elective CABG 1, 2, 3
- Prasugrel: Discontinue at least 7 days before elective CABG 1, 2, 3
- Aspirin: Continue perioperatively (this is the exception—do NOT stop) 1, 3
Anticoagulants
- Enoxaparin: Discontinue 12-24 hours before surgery and bridge with unfractionated heparin 1, 2, 3
- Fondaparinux: Discontinue 24 hours before surgery and bridge with unfractionated heparin 1, 2, 3
- Bivalirudin: Discontinue 3 hours before surgery and bridge with unfractionated heparin 1, 2, 3
Glycoprotein IIb/IIIa Inhibitors
- Eptifibatide or tirofiban: Discontinue 2-4 hours before surgery 1, 2
- Abciximab: Discontinue at least 12 hours before surgery 1, 2
Supporting Evidence for Pregabalin Safety
Research demonstrates that pregabalin administered preoperatively before CABG is both safe and beneficial:
- Hemodynamic safety: Pregabalin 150 mg given before CABG did not alter hemodynamic parameters and was safe in cardiac surgical patients 4
- Pain reduction: Preoperative pregabalin significantly reduced postoperative pain scores at 4,12, and 24 hours after CABG 4
- Quality of recovery: Perioperative pregabalin (150 mg preoperatively, then 75 mg twice daily for 2 days postoperatively) improved overall quality of recovery, emotional state, physical comfort, and pain control after off-pump CABG 5
Clinical Bottom Line
Continue pregabalin through the day before CABG without interruption. The drug does not increase bleeding risk, does not interfere with surgical hemostasis, and provides beneficial analgesic effects that improve postoperative outcomes 4, 5. Focus your preoperative medication review on the antiplatelet agents, anticoagulants, and glycoprotein inhibitors listed above, which are the medications that genuinely require timing-specific discontinuation 1, 2, 3.