Pregabalin (Lyrica) Patient Information
FDA-Approved Indications
Pregabalin is FDA-approved for five specific conditions: neuropathic pain from diabetic peripheral neuropathy, postherpetic neuralgia (shingles pain), fibromyalgia, neuropathic pain from spinal cord injury, and as add-on treatment for partial-onset seizures in patients 1 month of age and older. 1
How to Take Pregabalin
Administration Guidelines
Take pregabalin by mouth with or without food—meals do not significantly affect absorption, so you can take it on your schedule without worrying about timing around eating. 1, 2
Divide your daily dose into 2 or 3 doses throughout the day as prescribed by your doctor. 1
Swallow capsules whole; the medication reaches peak blood levels approximately 1 hour after taking it. 2, 3
Starting Dose and Dose Increases
For Diabetic Nerve Pain
Your doctor will start you at 50 mg three times daily (150 mg total per day). 1
The dose may be increased to 100 mg three times daily (300 mg/day) within the first week based on how well it works and how you tolerate it. 1
The maximum recommended dose is 300 mg/day—higher doses (up to 600 mg/day) were studied but caused more side effects without providing additional benefit. 1
For Shingles Pain (Postherpetic Neuralgia)
Your doctor will start you at 75 mg twice daily or 50 mg three times daily (150 mg total per day). 1
The dose may be increased to 150 mg twice daily or 100 mg three times daily (300 mg/day) within the first week. 1
If pain relief is insufficient after 2-4 weeks at 300 mg/day and you tolerate the medication well, your doctor may increase the dose to 600 mg/day (300 mg twice daily or 200 mg three times daily). 1
Doses above 300 mg/day are reserved only for patients with ongoing pain who tolerate the lower dose well, as higher doses cause significantly more side effects and more people stop treatment due to adverse reactions. 1
For Fibromyalgia
- The typical dose range is 300-450 mg/day in divided doses, with a maximum of 600 mg/day. 4
For Seizures (Add-on Treatment)
Adults start at 150 mg/day and may increase to a maximum of 600 mg/day, divided into 2 or 3 doses. 1
Pediatric dosing is based on body weight—your child's doctor will calculate the appropriate dose. 1
How Quickly Pregabalin Works
You may notice pain relief within 1 week of starting treatment, with some patients experiencing improvement within 1.5-3.5 days. 4, 5
Allow at least 4 weeks at your prescribed dose to fully assess whether pregabalin is working for you. 4, 5
Common Side Effects
Most Frequent Side Effects
Dizziness occurs in 23-46% of patients—this is the most common side effect and is dose-related. 5
Drowsiness/sleepiness (somnolence) affects 15-25% of patients. 5
Dry mouth is commonly reported. 5
Constipation occurs but is less severe than with opioid pain medications. 5
Swelling of hands, feet, or legs (peripheral edema) affects about 10% of patients—this is particularly important if you have heart failure or obesity. 5
Weight gain can occur, especially with long-term use. 5
Headache is reported in up to 29% of patients. 6
Managing Side Effects
Starting with a lower dose and increasing gradually helps minimize dizziness and drowsiness. 5
These side effects are dose-dependent—if they become bothersome, your doctor may reduce your dose. 5
Be especially careful with activities requiring alertness (driving, operating machinery) until you know how pregabalin affects you. 5
Serious Warnings and Precautions
Breathing Problems
Pregabalin can cause serious, life-threatening breathing problems when combined with opioid pain medications (like oxycodone, morphine, hydrocodone), benzodiazepines (like Xanax, Valium, Ativan), or other sedating medications. 4
Tell your doctor about ALL medications you take, including over-the-counter drugs and supplements. 4
Fall Risk
Pregabalin increases your risk of falls, especially if you are elderly or taking other sedating medications—dizziness, drowsiness, and balance problems contribute to this risk. 5
Use caution when standing up from sitting or lying down, and consider using assistive devices if you feel unsteady. 5
Fluid Retention and Heart Failure
- If you have heart failure or significant leg swelling, pregabalin may worsen these conditions—tell your doctor immediately if you notice increased swelling or shortness of breath. 5, 7
Abuse Potential
Pregabalin is a Schedule V controlled substance because it has potential for abuse and dependence. 8
Do not share your medication with others, and store it securely. 8
Special Populations
Elderly Patients
- If you are 65 or older, your doctor will likely start you at a lower dose and increase it more slowly because older adults are more susceptible to dizziness, confusion, drowsiness, and falls. 5
Kidney Problems
If you have kidney disease, your doctor must reduce your dose—pregabalin is eliminated through the kidneys, and reduced kidney function causes the medication to build up in your body. 1, 2
Your doctor will calculate your kidney function before starting pregabalin and adjust your dose accordingly. 5
Pregnancy and Breastfeeding
- Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding—discuss the risks and benefits of continuing pregabalin. 1
Stopping Pregabalin
Never Stop Suddenly
Do not stop taking pregabalin abruptly—this can cause withdrawal symptoms including insomnia, nausea, headache, anxiety, sweating, and diarrhea. 1
Your doctor will taper your dose gradually over at least 1 week (and possibly longer) when discontinuing treatment. 1, 5
A typical tapering schedule might reduce your dose by 25-50% each week, but your doctor will create a plan specific to your situation. 5
Drug Interactions
Minimal Drug Interactions
Pregabalin does NOT interact with most other medications because it is not metabolized by the liver and does not affect liver enzymes. 2
Pregabalin does not bind to blood proteins, so it does not displace other medications. 2
Important Exceptions
Combining pregabalin with opioids, benzodiazepines, alcohol, or other sedating medications significantly increases drowsiness, dizziness, and risk of serious breathing problems. 4, 5
Antacids (like Tums or Maalox) do not affect pregabalin absorption, but proton pump inhibitors (omeprazole) and H2-blockers (famotidine) also do not require dose adjustment. 5
What to Tell Your Doctor
Before Starting Pregabalin
All medications you currently take, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements. 4
If you have kidney disease, heart failure, or a history of drug or alcohol abuse. 5, 8
If you are pregnant, planning pregnancy, or breastfeeding. 1
If you have a history of depression, suicidal thoughts, or mood disorders. 1
During Treatment
Report new or worsening swelling in your legs, feet, or hands. 5
Report increased drowsiness, confusion, or difficulty breathing, especially if you take other medications. 4
Report any thoughts of self-harm or suicide. 1
Report if the medication is not controlling your pain after 4 weeks at the prescribed dose. 4
Storage and Handling
Store pregabalin at room temperature away from moisture and heat. 1
Keep out of reach of children and pets. 1
Do not share your medication with others—pregabalin is a controlled substance prescribed specifically for your condition. 8
Expected Duration of Treatment
Pregabalin is intended for long-term, ongoing use to maintain pain control—it is not a short-term medication like antibiotics. 5
Do not expect to take pregabalin for just a few weeks or months; chronic neuropathic pain typically requires continuous treatment. 5
Even in frail elderly patients with limited life expectancy, continuing pregabalin for neuropathic pain is often appropriate if it provides symptom relief. 9, 5