Gabapentin & pregabalin

Gabapentin (brand name Neurontin) and pregabalin (brand name Lyrica) are two drugs that are structurally similar but can have slightly different effects. Together, they’re part of a family of medications called gabapentinoids. Gabapentinoids are prescription drugs that treat and prevent seizures (such as seizures caused by epilepsy). They may also be prescribed for chronic pain. If you’re taking gabapentin or pregabalin, either via prescription or from the illicit market, here's what you need to know.

How do gabapentin and pregabalin work?

Gabapentinoids work by stopping your body from releasing some of the chemicals associated with nerve pain (neuropathic pain).

What's the difference between gabapentin and pregabalin? 

We spoke to Emma Schwarcz, Clinical Director at Community Alcohol Drug Service Auckland, to ask this question. Emma explained that pregabalin acts quicker and in smaller doses than gabapentin. The peak effects of pregabalin are reached after about an hour; whereas gabapentin takes three to four hours.

There are many different reasons why a doctor might prescribe pregabalin rather than gabapentin.

Are more people being prescribed gabapentinoids?

Emma says prescribing of these medicines has gone up across the country. She suggests it could be due to concerns around prescribing opioids and GPs looking for alternatives to help treat chronic pain.

“[There were] concerns around being able to use opioids with chronic pain [particularly relating to long term use and the potential to become tolerant to the dose level or overdose], so there was a shift to ‘OK, what can we use [instead]’.”

 - Emma Schwarz, Clinical Director, Community Alcohol & Drug Service Auckland

How do gabapentinoids make you feel?

Gabapentinoids can make you feel drowsy, dizzy and calm. You could also experience headaches and nausea. You might get mood changes, confusion, loss of coordination, or vision changes. If you take pregabalin or gabapentin that’s prescribed to you, talk to your doctor if any side effects are troublesome.

Some people access gabapentanoids that hasn’t been prescribed to them, from the illict market. Ryan* has used both pregabalin and gabapentin in social settings – “initially, just to see what it was like.” He says the feeling of pregabalin “was somewhat similar to GHB, that feeling of being confident, as if drunk, but not sloppy...there’s the euphoria, the feeling of being inebriated.”

Some people find they experience cravings to use gabapentinoids, and people who use them for a longer period of time  may experience withdrawal symptoms when they try to stop or cut down.

What does an overdose on gabapentin or pregabalin look like? 

Clara Dawkins, a Medical Officer at CADS Auckland, told us that taking gabapentinoids can slow down your breathing and put you at risk of an overdose. This risk of slowed or stopped breathing is higher if you’ve taken pregabalin or gabapentin with other depressants, like alcohol, opioids or benzos. She said that difficulty breathing can happen quickly, and getting medical care there as quickly as possible by calling 111 is crucial.

Even if the interactions between gabapentinoids and other drugs don’t cause a medical emergency, they can be unpleasant. Ryan told us that one of the most important harm reduction tips that he would give to people thinking about using pregabalin is to be aware of the risks when using pregabalin and alcohol at the same time. As well as the risk of these drugs slowing or stopping your breathing, he described one experience when he mixed pregabalin with alcohol where the pregabalin “seemed to really kick into gear” and he ended up talking to someone who wasn’t there.

If you or someone you know has taken gabapentinoids and they are having difficulty breathing, won’t wake up or are unresponsive, call an ambulance straight away.

What can withdrawal from gabapentinoids look like?

Emma says that withdrawal from gabapentinoids can feel a bit like withdrawal from alcohol and benzos: “nausea, irritability, can’t sleep, feeling sweaty, and tremors; and the return of other things like pain and anxiety.” Clara added that some people might find that they develop a tolerance to gabapentinoids relatively quickly.

Mark*, who was prescribed pregabalin (among other medications) for pain relief after an injury, agrees that withdrawal symptoms can be rough. One day after a couple of months of being on pregabalin, Mark missed his morning dose. By the end of the day, he was starting to experience unpleasant effects. 

“I got to about four or five o’clock and felt incredibly uncomfortable in my own skin. [I was] incredibly anxious, not able to stay still, not able to talk to anyone... really yuck. I then took my dose and it came right.”

- Mark, on experiencing withdrawal symptoms from prescribed pregabalin

What should you do if you want to stop using or cut down your use of gabapentin or pregabalin?  

If you’re wanting to change how you’re using pregabalin or gabapentin, it’s a good idea to talk to your GP or your local alcohol and drug service. They can help you come up with a plan to taper your use, as well as support you to manage withdrawal symptoms.

Everyone we spoke to reflected on how talking to a health professional about drugs can feel uncomfortable, especially if you haven’t been prescribed these medications. While speaking to a health professional is preferable as they can support you with withdrawal symptoms, if you don’t feel like you can do that, Clara suggested slowly reducing the amount that you use. Stopping gabapentanoids suddenly can cause seizures, which can be dangerous.

How can you stay safer if you’re taking gabapentin or pregabalin?

• If you’re taking pregabalin or gabapentin bought off the illicit market, get it checked to find out what’s in it. Find a drug checking clinic near you via our calendar.
• Avoid mixing gabapentanoids with other drugs, particularly depressants like alcohol, opioids, GHB or benzos. This combo can slow down or stop your breathing.
• If you are taking pregabalin in combination with opioids (such as heroin, codeine or oxycodone), consider having naloxone available. Naloxone is a medicine that temporarily reverses an opioid overdose, and you can get it free from your GP or local needle exchange.
• As with any drug, start with a low dose and wait to feel the effects before deciding if you’ll take more.

If you want support around gabapentinoids, ask your GP or local alcohol and other drugs service. You can also visit Healthpoint to find out what support services are available in your area.

Emma Schwarcz is a Clinical Director at CADS, and Addiction Psychiatrist.
Clara Dawkins is a Medical Officer at CADS, and an AOD Advisor, FRNZCGP, and Addiction Medicine Advanced Trainee RACP.

*Not their real names.