Pregabalin, commonly known by the brand name Lyrica, is a medication that treats some types of epilepsy and neuropathic pain associated with diabetes, shingles, or spinal cord injury.
The drug has the potential to be abused for the euphoric high it produces at elevated doses, most commonly used to enhance the effect of heroin and opioids. Read more to learn about pregabalin and pregabalin addiction.
| Generic name: | Pregabalin |
| Brand name: | Lyrica |
| Dosages: | 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, and 300mg |
| Drug class: | Anticonvulsants |
- Pregabalin is believed to work by inhibiting calcium channels in the central nervous system (CNS) and may indirectly reduce the release of many neurotransmitters.
- Pregabalin is primarily an anti-epileptic drug (AED), prescribed for epilepsy with partial seizures. It's believed to stop seizures by reducing abnormal electrical activity in the brain.
- People who use pregabalin recreationally take very large doses and are at risk of overdose. Typically, the effects of pregabalin overdose are mild, featuring mild sedation and occasionally seizures.
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What is pregabalin?
Pregabalin is a prescription medication used to treat epilepsy, neuropathic pain, anxiety, and other conditions. Like the closely related medication gabapentin, pregabalin is a precursor to GABA, a neurotransmitter produced by the body.[1] Pregabalin is believed to work by inhibiting calcium channels in the central nervous system (CNS) and may indirectly reduce the release of many neurotransmitters.[2] Compared to gabapentin, pregabalin has higher potency, faster rates of absorption, and higher bioavailability.[3]
Pregabalin can elicit feelings of euphoria and relaxation that users compare to drunkenness. This, along with the red and white coloring on 300mg capsules, has led to the street names “Budweiser” or “buds.”[4] Pregabalin may also be known as “Fizzers.”
People abuse pregabalin on its own or use it to augment the euphoric effects of opioids. Opioid users may knowingly take pregabalin, or they may be unwittingly exposed to it as a “cutting agent” in street supplies of heroin and opioids.[3]
Brand names for pregabalin
Pregabalin is marketed in the U.S. under the brand name Lyrica and Lyrica CR, the latter for extended-release tablets.[5] It’s marketed under a host of other names in other countries, including Gabamax, Gabanext, Nova, Pregab, Pregaba, and many others.
What is pregabalin used for?
Pregabalin is primarily an anti-epileptic drug (AED), prescribed for epilepsy with partial seizures. It's believed to stop seizures by reducing abnormal electrical activity in the brain.[7]
Pregabalin is also used to treat neuropathic pain, including that emerging from diabetes, shingles, herpes, and spinal cord injuries. It’s thought to alleviate neuropathic pain—which isn’t responsive to common painkillers—by slowing down the transmission of pain messages up the spine and to the brain.[8]
Pregabalin is also prescribed to manage anxiety, pain in fibromyalgia, restless leg syndrome, opioid withdrawal, and migraines.
Pregabalin dosage
In the U.S., Lyrica is available in capsules of the following strengths:[9]
- 25mg
- 50mg
- 75mg
- 100mg
- 150mg
- 200mg
- 225mg
- 300mg
Pregabalin has a relatively short elimination half-life of 6.3 hours.[10] That means patients take it two to three times a day to maintain adequate therapeutic levels of the medication in their systems.
The amount of pregabalin you take depends on the condition you’re treating and your tolerance for the medication.[11]
- for partial-onset seizures: starting at 150mg, given in two to three divided doses, and up to 600mg/day
- for diabetic neuropathic pain: starting at 50mg three times a day, no more than 300mg/day
- for fibromyalgia: starting at 75mg twice a day, no more than 450mg/day
- for postherpetic neuralgia: starting at 75mg to 100mg twice a day or 50 to 100mg three times a day, and up to 600mg/day
People who abuse gabapentinoids usually take much larger doses—typically three to 20 times therapeutic doses—to amplify the euphoric effects of the drug.[3]
Pregabalin side effects
Pregabalin may cause side effects, including:[12]
- Fatigue
- Dizziness
- Elevated mood
- Headache
- Nausea
- Vomiting
- Dry mouth
- Constipation
- Gas and bloating
- Forgetfulness
- Difficulty concentrating
- Lack of coordination
- Loss of balance or unsteadiness
- Slurred speech
- Increased appetite
- Weight gain
If you’re taking the medication for a legitimate medical reason, these may decrease as you become used to it. This is why patients usually start at a lower dose before titrating up to a higher dose.
Pregabalin overdose
People who use pregabalin recreationally take very large doses and are at risk of overdose. Typically, the effects of pregabalin overdose are mild, featuring mild sedation and occasionally seizures.[13]
However, when pregabalin is combined with other central nervous system depressants such as opioids and benzodiazepines, the sedation can compound and can cause respiratory depression and arrest, coma, and death.[13][14]
Is pregabalin addictive?
Pregabalin isn’t thought to be addictive when taken at prescribed doses for legitimate medical purposes such as epilepsy and neuropathic pain. However, at supratherapeutic (higher than prescribed) doses, it’s known to produce rewarding effects, including euphoria, dissociation, relaxation, sedation, and even psychedelic effects.[15] It may have an impact, either direct or indirect, on the dopaminergic reward systems that are hijacked and distorted during addiction.[3]
One review collected reports of behavioral and physiological dependence on gabapentinoids (pregabalin and gabapentin). It found that symptoms of behavioral dependence—including cravings, drug-seeking, and loss of control—were much more common with pregabalin (79% of case reports) compared to gabapentin (8% of case reports). However, only four individuals displayed signs of behavioral addiction (all to pregabalin) without a history of addiction to another substance. The review also found no reports of anyone seeking treatment for gabapentinoid abuse alone.[16] This suggests that gabapentinoids may be abused but almost exclusively by people with a history of addiction to other substances.
This conforms with reports that gabapentinoids are commonly used in combination with heroin and opioids and are said to enhance an opioid high and lessen the effects of withdrawal. One study estimated the prevalence of gabapentinoid abuse in the general population at 1.6%, while the prevalence among opioid abusers was estimated at between 3% to 68%.[17]
Pregabalin has also been reported to be abused in combination with alcohol, cannabis, LSD, amphetamines, and GHB.[15]
Pregabalin has been a Schedule V controlled substance in the U.S. since its release in 2005, in recognition of its potential for abuse.[15]
Pregabalin withdrawal
In one review, 84% of patients given pregabalin display tolerance and withdrawal symptoms when it’s abruptly stopped.[16]
Lyrica withdrawal symptoms reported in medical literature include:[18]
- Anxiety
- Insomnia
- Delusions
- Hallucinations—visual and auditory
- Suicidal ideation
- Psychomotor agitation
- Delirium
- Terror
- Depressed mood
These withdrawal symptoms can manifest after just a few weeks of pregabalin use. To avoid withdrawal, users are often advised to taper down their dosage over weeks or months.
Pregabalin addiction treatment
Pregabalin abuse is increasingly common among opioid users as well as others with polysubstance dependence. Some people may also become addicted to pregabalin alone, using more than prescribed, using it to unwind or avoid problems, and experiencing cravings when they don't use it.
Pregabalin abuse can complicate detoxification and recovery from drug addiction, so you should be honest about your pregabalin use when seeking addiction treatment. Treatment may include a supervised taper off pregabalin and other abused substances, psychological therapy, and support groups.
