Can Lyrica (pregabalin) cause tiredness and dizziness, leading to feelings of wobbliness?

Can Lyrica Cause Tiredness and Wobbliness?

Yes, Lyrica (pregabalin) commonly causes both tiredness (somnolence) and wobbliness (dizziness), which are among its most frequent and characteristic side effects. These symptoms occur in a substantial proportion of patients and are dose-dependent, typically beginning shortly after starting the medication.

Frequency and Characteristics of These Side Effects

Dizziness (Wobbliness)

• Dizziness occurs in 23-46% of patients taking pregabalin, compared to only 8% on placebo in controlled trials 1, 2
• The sensation of wobbliness stems from dizziness, which can impair balance and coordination 1
• Dizziness is the most common adverse reaction leading to treatment withdrawal (4% of patients) 2
• In 30% of patients who experience dizziness, the symptom persists until the last dose of treatment 2

Tiredness (Somnolence)

• Somnolence affects 15-25% of pregabalin-treated patients, compared to 8% on placebo 1, 2
• Somnolence is also one of the most frequent reasons for discontinuing pregabalin (4% withdrawal rate) 2
• In 42% of patients experiencing somnolence, the symptom persists throughout treatment 2

Dose-Dependent Nature

Both dizziness and somnolence are clearly dose-dependent, meaning higher doses cause these side effects more frequently 2, 3:

• At 300 mg/day: dizziness occurs in 13-29% of patients, somnolence in 11-16% 1
• At 600 mg/day: dizziness occurs in 22-35% of patients, somnolence in 15-25% 1

Timing and Management

Onset

• These side effects generally begin shortly after initiating pregabalin therapy 2
• Symptoms typically appear within the first week of treatment 2

Management Strategies

• Both dizziness and somnolence can be managed by dose reduction without necessarily discontinuing therapy 4, 3
• Starting at the lowest possible dose (75 mg at bedtime or 50 mg three times daily) and increasing gradually minimizes these effects 1, 4
• For elderly patients or those with renal impairment, even lower starting doses (25-50 mg/day) with slower titration are recommended 1, 4

Critical Safety Warnings

Impairment of Function

• Pregabalin-related dizziness and somnolence may impair the ability to perform tasks such as driving or operating machinery 2
• Patients should be explicitly warned not to drive or work with machines until they know how pregabalin affects them 2

Increased Risk with Other Medications

• The risk of dizziness and sleepiness is significantly higher when pregabalin is combined with opioid pain medications, benzodiazepines, or other CNS depressants 2
• Alcohol consumption while taking pregabalin increases side effects including sleepiness and dizziness 2

Fall Risk in Elderly Patients

• Elderly patients are particularly vulnerable to falls, confusion, and sedation from pregabalin 1, 4
• The combination of dizziness and somnolence creates an unacceptable fall risk in older adults 1

Common Pitfalls to Avoid

• Do not assume these side effects will resolve on their own without dose adjustment - while tolerance may develop in some patients within a few weeks 5, persistent symptoms require dose reduction 4, 3
• Do not combine pregabalin with gabapentin thinking it will reduce side effects - both medications have identical adverse effect profiles and create additive sedative burden 1, 4
• Do not abruptly discontinue pregabalin if side effects are intolerable - taper gradually over at least one week to avoid withdrawal symptoms 2
• Do not overlook renal function - pregabalin is 85-98% renally excreted, and failure to adjust doses in renal impairment dramatically increases side effects 1, 6