Pregabalin Addiction

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Page Clinically Reviewed on 16 June 202412 September 2024 by Kerry Canning, MBChB | Medical Editor

Key Takeaways

• Pregabalin is a prescription medication used in the management of seizures, nerve pain and generalised anxiety disorder (GAD) 
• Brand names for pregabalin include Alzain, Axalid and Lyrica
• In April 2019, pregabalin was reclassified as a Class C controlled substance in the UK, due to misuse concerns
• Individuals with a current or previous substance use disorder are at increased risk of becoming addicted to pregabalin
• Addiction to pregabalin can occur without a history of drug misuse, following prescription for an approved use
• Taking pregabalin alongside alcohol and/or opioids can be dangerous and result in fatal consequences
• Stopping pregabalin suddenly should be avoided as this can lead to withdrawal symptoms such as anxiety, nausea, pain and seizures
• Addiction can predominate an individual’s life and negatively impact physical, psychological and social well-being
• Management of pregabalin addiction can occur in inpatient or outpatient settings and can feature assisted withdrawal and psychosocial interventions

Pregabalin Overview

Pregabalin is a new-generation anticonvulsant medication that is prescribed to manage seizures, nerve pain and generalised anxiety disorder (GAD). The prescribed dose of pregabalin varies between 50–600 mg daily, which is given in divided doses.^1–3

Pregabalin is available in capsule, tablet or liquid form and has different brand names, such as Alzain, Axalid and Lyrica. It is more potent than gabapentin, which works in a similar way and is used to treat seizures, nerve pain and migraines.2,4 Due to similarities between pregabalin and gabapentin, these medications can be grouped together as gabapentinoids^.5 

In 2019, pregabalin was reclassified as a Class C controlled substance in the UK, due to concerns over misuse and addictive potential.1 This led to strict rules being implemented for the prescription and dispensing of this medication. These rules include^2,6:

• Doctors need to sign the physical prescription, rather than sending electronic copies to pharmacies 
• Pregabalin must be dispensed by the pharmacy within 28 days of the written prescription
• Proof of identity needs to be shown when collecting pregabalin from a pharmacy

It is recommended that healthcare professionals obtain a full history from patients prior to prescribing pregabalin, to determine whether they have a current or previous substance use disorder. Pregabalin should be used with caution in patients with a substance misuse history and careful monitoring for signs of misuse should be carried out throughout treatment.¹

Misuse of pregabalin can lead to addiction, however, it tends to exhibit lower potential for addiction and abuse than some other drugs, particularly in individuals without a history of substance misuse. Despite this, misuse rates of pregabalin have been shown to be over 81% in patients experiencing nerve pain related to spinal cord injury. Additionally, administering pregabalin alongside other psychoactive drugs, such as opioids and sedatives can be extremely dangerous and can lead to fatal overdose.^5,7 

Stopping pregabalin treatment suddenly should be avoided, as this can lead to withdrawal symptoms, including²:

• Seizures
• Difficulty sleeping 
• Anxiety 
• Pain 
• Nausea 
• Sweating

Effects of Pregabalin Addiction 

Signs and Symptoms of Pregabalin Misuse 

Prescribed use of pregabalin can commonly result in side effects, such as headaches, diarrhoea, mood changes, dizziness and drowsiness^.1

Misuse can occur with prescribed or illicitly obtained pregabalin. Individuals who are addicted to illicit drugs widely misuse pregabalin. It is a growing problem, with 409 deaths by poisoning mentioning pregabalin in 2021, a rise of 18% from the previous year.⁴

Pregabalin addiction can lead to various physical, psychological and social effects. These can be different for everyone and depend on whether someone has taken pregabalin or is withdrawing from it. 

Whilst under the influence of pregabalin, an individual can experience various physical and psychological effects. These can include changes in brain functioning, increased appetite and feelings of elation and high energy. 

Addiction to pregabalin can also be marked by various social and behavioural changes. These can include³:

• Participating in risky behaviours, such as stealing or taking out loans, to fund the addiction
• Relationship breakdowns
• Poor work performance 
• Loss of job and income 

Pregabalin addiction can immensely impact an individual’s life and well-being. It can also be dangerous and even fatal, particularly when pregabalin is combined with other substances, such as opioids or alcohol.¹

Diagnosing Pregabalin Addiction 

A substance use disorder, or addiction, can be characterised by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. These criteria are divided into four primary categories: impaired control, physical dependence, risky use and social issues. 

According to the DSM-5 criteria, an individual experiencing drug addiction can exhibit the following behaviours:

• Taking a higher dose or taking a drug for a longer duration than recommended
• Intending to reduce or stop use but being unable to 
• Experiencing cravings for the drug 
• Investing significant amounts of time in sourcing, using or recovering from the drug
• Faltering in responsibilities at home, work or school 
• Reduced participation in important social or occupational activities 
• Repeated use despite negative or dangerous consequences 
• Continued use despite relationship breakdowns 
• Continued use despite physical and/or psychological issues 
• Developing tolerance, whereby more of the drug is needed to produce the same effects
• Development of withdrawal symptoms when use is reduced or stopped that can be alleviated by drug use 

The presence of two or more of these symptoms suggests that an addiction has developed. The severity of the addiction can be rated as mild (2–3 symptoms), moderate (4–5 symptoms) or severe (6 or more symptoms)^.8

Pregabalin in Combination With Other Substances 

As a central nervous system (CNS) depressant and psychoactive substance, pregabalin can affect brain and CNS functioning. If taken alongside other CNS depressants, like alcohol, opioids and some prescription medications, the effects may be additive and could become life-threatening. A combination of CNS depressants can result in sedation, drowsiness and/or breathing difficulties, which can have fatal consequences. Respiratory failure and coma have been reported in patients taking multiple CNS depressant medications, including pregabalin.

The use of pregabalin alongside strong painkillers, such as morphine and oxycodone, can also produce unwanted effects. In these cases, drug doses may be amended and patients may be closely monitored for side effects.⁹

When to Seek Help 

If for any reason you are taking pregabalin that hasn’t been prescribed or are taking it in higher doses than recommended, you may have developed a pregabalin addiction. You may also have been taking it for some time under prescription instructions but are concerned about the effects on your physical and mental health. In either instance, it is important to learn more about these signs and symptoms to empower you to seek medical help. 

If you recognise any of these signs or symptoms in yourself or someone you know, it is important to reach out for help. Anyone can experience addiction and symptoms can manifest in different ways. If your physical and/or mental health is impacted or you think you may have developed pregabalin addiction, we recommend that you promptly seek medical help.

Pregabalin Withdrawal 

Symptoms of Pregabalin Withdrawal 

Suddenly stopping pregabalin treatment is not recommended, as this can lead to significant psychological and physical symptoms. The dose of pregabalin should be reduced gradually to avoid these symptoms. 

Pregabalin withdrawal symptoms can include:

• Anxiety 
• Panic attacks 
• Agitation or irritability
• Restlessness 
• Palpitations 
• Shaking 
• Sweating 
• Nausea 
• Difficulty sleeping 
• Body aches 
• Seizures 

These withdrawal effects and other side effects can be amplified if other drugs are used alongside pregabalin, such as heroin or cannabis. Memory loss, anxiety and panic attacks can occur when these substances are used together. Use of alcohol with pregabalin should also be avoided as this can lead to drowsiness and breathing difficulties.²

Pregabalin in Substance Misuse and Withdrawal Management 

Some studies have shown that pregabalin could be useful in the management of alcohol, nicotine, benzodiazepine, cannabinoid and opioid dependence and/or withdrawal. However, there is limited evidence to support this and further clinical trials are needed to assess for efficacy and safety. The risks of pregabalin abuse should also be recognised and healthcare professionals should demonstrate caution when prescribing pregabalin to patients with a substance use disorder history.¹⁰

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Pregabalin Addiction Treatment 

Treatment for pregabalin addiction can vary depending on various factors such as personal circumstances, co-occurring conditions and patterns of pregabalin misuse.

Tapering Schemes

Individuals should withdraw from pregabalin gradually to avoid potentially significant withdrawal symptoms. Suggested tapering schemes advise that the daily dose of pregabalin should be reduced at a maximum of 50–100 mg per week. The summary of product characteristics for pregabalin indicates that it can be discontinued over the course of one week, however, more gradual tapering allows for closer monitoring of withdrawal symptoms.⁹  

Assisted Withdrawal 

If an individual is using drugs and/or alcohol in addition to pregabalin, they may benefit from assisted withdrawal in inpatient or outpatient settings. Gradual reductions in pregabalin doses over approximately 30 days in the community and 14–21 days as an inpatient can help alleviate withdrawal symptoms and achieve sobriety. Reduction rates are quicker in inpatient settings as individuals are closely monitored and other medications are available to help manage symptoms. 

For individuals who experience seizures or epilepsy, identifying and monitoring for substance use disorders is recommended. Healthcare professionals, such as neurologists, are advised to perform urine drug screens, blood tests and alcohol breath tests to evaluate the presence of misused substances.

In cases where a doctor has prescribed pregabalin to someone with epilepsy and a substance use disorder, inpatient and residential units are recommended to provide medically assisted withdrawal services. In these cases, another anticonvulsant medication, such as carbamazepine, may be prescribed in addition to medications used for alcohol withdrawal.⁴

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Counselling or Talk Therapy 

Therapy and/or counselling can be beneficial in the management of addictive behaviours. These approaches can help to address underlying mental health conditions and provide support and guidance for individuals experiencing addiction.

Individual or group therapy sessions can empower understanding of how mood, thoughts and emotions impact behaviours. This can help an individual to restructure their thoughts or responses to certain situations.11

At Castle Craig, our team of qualified addiction counsellors can provide you with specialist addiction therapy. Our therapists have an understanding of co-occurring issues surrounding addiction and have devised effective programmes and plans to help you overcome addiction.

Support Groups 

Attending self-help or support groups can aid recovery from addiction as they provide a platform to share experiences, overcome isolation and gain support and advice from peers. These groups can support individuals with addictions, such as pregabalin addiction, and their families and friends. As such, they can be a useful tool on the road to addiction recovery^.11

Groups such as Narcotics Anonymous¹² can also assist in maintaining sobriety. In these groups, individuals have experienced addiction and are now dedicated to supporting themselves and others through recovery.

Rehabilitation 

Psychosocial rehabilitation can be a helpful component of pregabalin addiction treatment. It can provide individuals with coping skills and resources for tackling stressful situations^.11

Inpatient rehabilitation within a specialist unit can also be a crucial step towards recovery, particularly for individuals who are using other substances, such as alcohol or heroin, alongside pregabalin. 

If you are concerned about the usage of Pregabalin in your life, talk to us – we know how to help.

If you, a friend, or a family member let you know more about Castle Craig’s residential rehab programme. Please call our 24-Hour Helpline: +01721 546 263.

How Can Castle Craig Help? 

At Castle Craig, our inpatient facility offers specialist care and medically supervised detoxification. The immersive nature of inpatient rehab provides a structured and supportive environment, with 24-hour medical and emotional support. It also offers a safe space away from triggers and a comprehensive treatment plan that includes detox, therapy and skills training for relapse prevention. Inpatient rehabilitation can involve staying at Castle Craig for typically 30 days to several months. View our foundation programme here to learn more. 

At Castle Craig, therapy plans are tailored to each person’s needs, ensuring a comprehensive and effective approach to rehabilitation and recovery. 

Following our medically supervised detox process, you’ll enter our recovery programme, where you can benefit from personalised treatment plans involving a variety of approaches. These include individual and group therapy sessions, where targeted programmes can help address co-occurring conditions, such as eating disorders, depression or trauma.

As a leading drug addiction treatment centre, Castle Craig is at the forefront of prescription drug addiction. We have seen a rise in pregabalin addiction cases coming into our rehabilitation facility.

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