Pregabalin, sold under the brand name Lyrica among others, is an anticonvulsant, analgesic, and anxiolytic amino acid medication used to treat epilepsy, neuropathic pain, fibromyalgia, restless legs syndrome, opioid withdrawal, generalized anxiety disorder (GAD), and postherpetic neuralgia (a type of nerve damage that can result from shingles). Pregabalin also has antiallodynic properties. Its use in epilepsy is as an add-on therapy for partial seizures. When used before surgery, it reduces pain but results in greater sedation and visual disturbances. It is taken by mouth. Common side effects can include headache, dizziness, sleepiness, euphoria, confusion, trouble with memory, poor coordination, dry mouth, problems with vision, and weight gain. Serious side effects may include angioedema, kidney damage, and seizures. As with all other drugs approved by the FDA for treating epilepsy, the pregabalin labeling warns of an increased suicide risk when combined with other drugs. When pregabalin is taken at high doses over a long period of time, addiction may occur, but if taken at usual doses the risk is low. Use during pregnancy or breastfeeding is of unclear safety. It is a gabapentinoid medication, a class of drugs within the chemical derivatives of γ-aminobutyric acid (GABA analogues), an inhibitory neurotransmitter. Although pregabalin is inactive at GABA receptors and GABA synapses, it acts by binding specifically to the α2δ-1 protein that was first described as an auxiliary subunit of Voltage-gated calcium channels. Pregabalin was approved for medical use in the United States in 2004. In the US, pregabalin is a Schedule V controlled substance under the Controlled Substances Act of 1970, which means it has low abuse potential compared to substances in Schedules I–IV, though there is still a potential for misuse. It is available as a generic medication. In 2023, it was the 78th most commonly prescribed medication in the United States, with more than 8 million prescriptions.
Medical uses
Seizures For drug-resistant focal epilepsy, pregabalin is useful as an add-on therapy to other treatments. Its use alone is less effective than some other seizure medications. It is unclear how it compares to gabapentin for this use.
Neuropathic pain The European Federation of Neurological Societies recommends pregabalin as a first-line agent for the treatment of pain associated with diabetic neuropathy, post-herpetic neuralgia, and central neuropathic pain. A minority obtain substantial benefit, and a larger number obtain moderate benefit. It is given equal weight as gabapentin and tricyclic antidepressants as a first-line agent, though the latter are less expensive as of 2010. Pregabalin is as effective at relieving pain as duloxetine and amitriptyline. Combination treatment of pregabalin and amitriptyline or duloxetine offers additional pain relief for people whose pain is not adequately controlled with one medication and is safe. Studies have shown that higher doses of pregabalin are associated with greater efficacy. Pregabalin's use in cancer-associated neuropathic pain is controversial, though such use is common. It has been examined for the prevention of post-surgical chronic pain, but its utility for this purpose is controversial. Pregabalin is generally not regarded as efficacious in the treatment of acute pain. In trials examining the utility of pregabalin for the treatment of acute post-surgical pain, no effect on overall pain levels was observed, but people did require less morphine and had fewer opioid-related side effects. Several possible mechanisms for pain improvement have been discussed.
Anxiety disorders Pregabalin is effective for treatment of generalized anxiety disorder. It is also effective for short- and long-term treatment of social anxiety disorder and in reducing preoperational anxiety. However, there is concern regarding pregabalin's off-label use due to the lack of strong scientific evidence for its efficacy in multiple conditions and its proven side effects. The World Federation of Biological Psychiatry recommends pregabalin as one of several first line agents for the treatment of generalized anxiety disorder, but recommends other agents such as those of the selective serotonin reuptake inhibitor (SSRI) class as first-line treatment for obsessive–compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). For PTSD, pregabalin as complementary treatment seems to be effective.
Generalized anxiety disorder Pregabalin has anxiolytic effects similar to benzodiazepines with less risk of dependence. The effects of pregabalin appear within one week of use, and are similar in effectiveness to lorazepam, alprazolam, and bromazepam, but pregabalin has demonstrated superiority by producing more consistent therapeutic effects for psychosomatic anxiety symptoms. Long-term trials have shown continued effectiveness without the development of tolerance, and, in addition, unlike benzodiazepines, it has a beneficial effect on sleep and sleep architecture, characterized by the enhancement of slow-wave sleep. It produces less severe cognitive and psychomotor impairment compared to benzodiazepines. A 2019 review found that pregabalin reduces symptoms, and was generally well tolerated.
Other uses Although pregabalin is sometimes prescribed for people with bipolar disorder, there is no evidence that it is effective. There is no evidence and significant risk in using pregabalin for sciatica and low back pain. Evidence of benefit in alcohol withdrawal as well as withdrawal from certain other drugs is limited as of 2016. There is no evidence for its use in the prevention of migraines and gabapentin has also been found not to be useful. A 2025 review found possible benefits to sleep quality in patients with fibromyalgia.
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