How Do These Drugs Work?
Lyrica is the brand name for the drug pregabalin, and gabapentin is the name of the medication that is used in drugs such as Neurontin, Gralise, and Horizant. All of these drugs are prescribed as anticonvulsant or antiepileptic medications. Pregabalin and gabapentin are structurally similar to the brain chemical (neurotransmitter) gamma-aminobutyric acid (GABA), which is the major inhibitory neurotransmitter in the central nervous system.1
The exact way that Lyrica and gabapentin work is not well understood, but they do not appear to act on GABA neuronal systems, as one would expect given their chemical structure. Instead, they may bind to voltage-gated calcium channels in the central nervous system (CNS), which may decrease neurotransmitter release throughout the CNS.1
Differences Between Lyrica (Pregabalin) and Gabapentin
In the U.S., medicines containing gabapentin are approved to treat seizures, post-herpetic neuralgia, and restless legs syndrome. Gabapentin also has numerous off-label uses, including the management of neuropathic pain, insomnia, anxiety, bipolar disorder, menopausal conditions (i.e., hot flashes), vertigo, itching of the skin, and migraines.
A major difference between Lyrica and gabapentin is that the DEA has classified Lyrica as a controlled substance.
Lyrica is also approved to treat seizures and post-herpetic neuralgia. In addition, it can treat neuropathic (nerve) pain associated with diabetes (i.e., diabetic peripheral neuropathy) and pain associated with fibromyalgia.
A major difference between Lyrica and gabapentin is that the Drug Enforcement Administration (DEA) has classified Lyrica as a controlled substance (listed in Schedule V), whereas medicines containing gabapentin are not currently scheduled as controlled substances. This means that Lyrica and substances containing pregabalin are considered to have some potential for abuse and physiological dependence.
Despite not being a scheduled, controlled substance, there are documented cases of gabapentin abuse. A review of cases of gabapentin misuse found that the main reasons people abused the drug were to get high, ease opioid withdrawal symptoms, and increase the effects of methadone. Another study found that the rates of abuse ranged from 40% to 65% among people with a prescription for the drug and 15% to 22% among populations that abuse opioids. Many people who abused the drug had a history of substance abuse.
A review of the 2 drugs concluded that “pregabalin appears to have some distinct pharmacokinetic advantages over gabapentin.” Lyrica appears to be absorbed more rapidly than gabapentin, with peak blood plasma concentrations occurring within 1 hour. The amount of the drug in a person’s system (bioavailability) also remains the same regardless of the dose. In contrast, gabapentin’s bioavailability decreases from 60% to 33% when the dose is increased from 900mg to 3600mg per day.
In addition, Lyrica may be a relatively more potent anticonvulsant and neuroleptic medication—leading to a greater reduction in seizure frequency in patients and being more effective for treating neuropathic pain.
Finally, both drugs can lead to withdrawal if a person suddenly stops using them or reduces the dose. Abrupt cessation can lead to status epilepticus in patients (seizures that don’t stop).6
Gabapentin withdrawal symptoms include:
- Lack of control over muscle movements.
Pregabalin withdrawal symptoms include:
- Sleep problems.
Experts recommend that people who are taking antiepileptic drugs taper off them gradually to reduce the risk of withdrawal symptoms and increased seizures. Lyrica may be gradually discontinued over the course of at least one week, but only your prescribing physician can best determine the right timeframe/tapering schedule for you.
If you have been misusing either or both of these medications, you could be at risk of a potentially complicated withdrawal, and should seek the help of a medical detox program or other medical professional guidance.
Side Effect Potential
Though the side effect profiles of both drugs are similar, some studies have found that Lyrica may have somewhat fewer of them. Dizziness and sleepiness are the most common side effects associated with both drugs, but more serious concerns such as suicidal ideation have also been reported.
Side effects of gabapentin include:
- Blurred vision.
- Memory problems.
- Dry mouth.
- Increased appetite.
- Weight gain.
- Back or joint pain.
- Ear pain.
- Runny nose.
- Flu-like symptoms.
- Red, itchy eyes.
- Poor coordination.
- Shortness of breath.
- Swelling of the face, tongue, lips, or eyes.
Side effects for Lyrica include:
The Bottom Line
Gabapentin and Lyrica are similar in their chemical composition and in the conditions they are approved to treat. However, some research studies suggest that Lyrica has some advantages, particularly with the control of certain types of pain.
Based on the current classification by the DEA, pregabalin is considered to have a higher risk for abuse and for the development of physical dependence than products containing gabapentin. The general rule is that both drugs be discontinued on a tapering schedule (lowering the dose at specific intervals) to avoid potential withdrawal symptoms even in individuals who use these drugs for medical reasons.
The decision to use products containing gabapentin or pregabalin should be made during a consult with one’s physician. A doctor will take into account your medical history, symptoms, age, and other factors before writing a prescription. If you are prescribed either drug, always take it according to your doctor’s instructions and never share your prescription with other people.
Fear and anxiety for legitimate users of pregabalin and gabapentin
Home Office proposals to reclassify both gabapentin and pregabalin – commonly used to treat neuropathic or nerve pain – as class ‘C’ substances, will make access to them more difficult. Publicity surrounding the proposal has also created fear and anxiety and left people who depend on gabapentin or pregabalin for pain relief, questioning the safety of the two medicines which, if used responsibly and with the right combination of support, can change the lives of people who have previously struggled to manage pain symptoms.
Heather Wallace, Chair of Pain Concern – a UK charity based in Scotland – acknowledges the rise in the number of deaths associated with pregabalin and gabapentin but says the circumstances around the alarming statistics haven’t been properly examined.
Heather said: “We have known for a long time that these medicines have been over-prescribed, but the people who find them beneficial for pain relief, haven’t misused them and feel they are being punished for something they haven’t done. In many cases it is difficult to find the right combination of pain relief, and we know from our helpline that people have been left fearful and confused by this proposal and all the publicity it has generated. It’s premature and risks harming people who are using these medicines because there is nothing else for them that works.”
Pain specialist Dr Pamela Bell believes that open and informed discussion between people living with pain and their GP about the benefits versus the risks of potential treatment, including the risks of dependency, addiction and interactions with other drugs, is vital. “We know many people who benefit from these medicines when they are appropriately prescribed and we share their concerns at moves to reclassify pregabalin and gabapentin. Many people tell us it has taken years for them to find the right combination of medication, physiotherapy and support that allows them a better quality of life and it will prove more difficult to access pregabalin and gabapentin when they are reclassified as controlled drugs.”
Pain Concern works to empower people living with long term pain to be proactive in managing their condition and has in response to the demand for trustworthy and reliable information on pain medication has produced three information leaflets on: gabapentin and pregabalin; amitriptyline and opioids. Written by pain experts, the leaflets provide up-to-date information and facts to help people discuss possible treatments and therapies with their GP or clinic.