Flash VIG-news: Pregabalin (Lyrica and generics): risks of misuse, abuse, and dependence

date: 30/11/2022

For several years, health authorities in European countries have noted a worrying increase in pregabalin abuse. Here are some reminders of the risks of misuse, abuse, and addiction with pregabalin.

Pregabalin (Lyrica and generics) is an analogue of gamma-aminobutyric acid (GABA) whose inhibitory properties on the nervous system it mimics. It is indicated for the treatment of peripheral and central neuropathic pain in adults, partial seizures with or without secondary generalisation and generalised anxiety disorder in adults.

The recommended daily dosage for pregabalin is 150-600 mg divided in two or three administrations for an adult without comorbidities that would justify a lower dose. 

Over the past several years, health authorities in European countries have noted a worrying rise in pregabalin abuse (40 % more patients since 2016). It was described mainly in two situations:
•    misuse (dose > 600 mg) of pregabalin by patients who use it for particular therapeutic indications (e.g. anxiety disorders, somatic pain);
•    in the context of (poly-)use of psychoactive substances where the anxiolytic, disinhibiting and euphoric properties of pregabalin are sought. 

Pregabalin abuse can lead to dependence as well as to various adverse effects such as an increased risk of suicide or aggressive behaviour. Some risk factors for increasing abuse have been identified and include: male gender, age between 18 and 45, presence of chronic pathologies, history of addiction, psychiatric comorbidities, multiple prescribers and low income. 

For any prescription and dispensing of pregabalin:
•    A medical, psychological and social history of the patient should be taken in order to identify patients at increased risk of misuse, abuse, and dependence (a potential compounding of vulnerabilities requires serious consideration).
•    No more than 600 mg/day should be prescribed and large quantities should not be prescribed too quickly.
•    In patients already being treated with pregabalin, attention should be paid to signs of misuse, abuse, development of tolerance with unilateral dose escalation by the patient, dependence and behaviours encouraging the prescription and dispensing of pregabalin.
•    Particular attention should be paid to the use of other psychoactive substances (risk of potentiation of effects, but also increased risk of respiratory depression).
•    A dosage reduction should be considered for all patients in whom (mainly renal) elimination of pregabalin is reduced (renal failure, advanced age) or for patients with conditions such as diabetes, respiratory or heart disease.

If it is necessary to discontinue pregabalin, the risk of withdrawal-related symptoms should not be underestimated. It is recommended that the treatment be discontinued gradually, over a period of at least one week, regardless of the indication for pregabalin.  

If you witness any case of misuse, abuse or addiction of pregabalin, or behaviours that encourage pregabalin prescribing or dispensing, we kindly ask you to report these to the FAMHP. Physicians and pharmacists are also asked to file a complaint with the police if they identify false prescriptions.

Last updated on 30/11/2022