Pregabalin and Gabapentin: Easy to start, difficult to stop!

April 30, 2024

3:57 pm

Gabapentin and Pregabalin

Pregabalin and gabapentin: Addictive, avoidable yet treatable in recovery

The gabapentinoid drugs gabapentin and pregabalin are anti epileptic drugs that are considered as first-line treatments for the management of neuropathic pain. Pregabalin is also approved for generalized anxiety disorders in the United Kingdom. The mechanisms of action are still unclear despite their widespread use. The gabapentinoids share similar mechanisms of action but differ considerably in their pharmacokinetic and pharmacodynamic characteristics.

In addition to the use in neuropathic pain, off-label use in primary care is common, accounting for more than half of the prescriptions in primary care in the United Kingdom. Off-label use includes management of a wide range of conditions such as bipolar disorder, complex regional pain syndrome, attention deficit disorder, restless legs syndrome, periodic limb movement, sleep disorders, headaches, alcohol withdrawal syndrome, chronic back pain, fibromyalgia, visceral pain and acute postoperative pain. The rate of new prescriptions is increasing and tripled in England from 2007 to 2017 Pregabalin prescriptions in England increased from 2.7 million scripts in 2013 to 7 million scripts in 2018. Similarly, gabapentin prescriptions increased from 3.5 million scripts to about 7 million scripts. This increase in prescription rates does not correlate with the evidence for effectiveness in clinical practice. This article aims to discuss some of the evidence for efficacy and suggests strategies to promote appropriate use in clinical practice. Development of gabapentin and pregabalin Gabapentin was first developed in the early 1970’s as part of efforts to discover drugs for treating neurological disorders. As with benzodiazepines, the work was around Gamma-aminobutyric acid which was known to be a key inhibitory neurotransmitter and by inhibiting this, seizures could occur. Gabapentin, as an anticonvulsant, was discovered by accident: Which is how most drugs are discovered! Pregabalin was also discovered this way. These two prescribed drugs, gabapentin and pregabalin, were initially developed for patients with epilepsy. However, up to 9-% of patients prescribed either of these drugs are not taking it for this reason but mostly for neuropathic pain and/or anxiety. While the research shows that there is a lower for potential for dependency on gabapentin than pregabalin, both can be very problematic. Dependency on pregabalin usually only occurs after a prolonged period. While it is not prescribed to assist people withdrawing from opioids (heroin) it is not uncommon for people dependent on opioids to use this to “get high”, especially when in treatment for opioid dependency. . If you stop taking Pregabalin, suddenly, then you can experience:

  • Trouble falling asleep or staying asleep
  • Anxiety
  • Tachycardia (abnormally rapid heart rate)
  • Diaphoresis (sweating)
  • Nausea
  • Aggression
  • Diarrhea
  • Headaches

While these symptoms may be self-limiting (they may go away by themselves without medical treatment) there have been a few cases of pregabalin and gabapentin withdrawal seizures. These are rare, and usually due to high amounts being taken and other underlying conditions, such as this interesting case in Australia However, it can happen, and they can cause delirium tremens (DT’s). For Gabapentin, many NHS Trusts, such as Arden and Greater East Midlands Commissioning Support Unit recommend that patients taking more than 900MG a day reduce by 300MG every ten days and for those taking less than 900MG, reduction at a rate of 100MG every ten days. With Pregabalin, a reduction of 100MG every ten days: Regardless of the total amount taken.

Clearly, this could mean a lengthy admission time into a rehabilitation Center. That is why patients often start a reduction plan in the community, with the support of their GP and then, at the latter stage, go into a rehab Center to complete the process. While, of course, there are some patients who could tolerate a faster reduction regime, it is not recommended. There is a danger that some centers will agree to a more rapid reduction regime to accommodate a client (and take a booking) as it would reduce the total cost of treatment. However, this would be unethical, unsafe and, in the long run, not cost effective if the patient relapses. The risk of relapse is always higher when a patient undertakes rapid detoxification. Such a process leaves a patient with cravings and a lowered tolerance to the drug: A potentially catastrophic combination. While, in theory, it is possible to detox from Gabapentin/Pregabalin at home, I would not recommend this. There are numerous alternatives to these drugs which do not attract the same issues when reducing/stopping. Gabapentinoids are now controlled items and GPs are under increasing scrutiny and pressure to reduce the prescribing of these items. For pain, there are a wide number of Anti-depressants that will provide an equal, if not a greater, amount of pain control that gabapentin/pregabalin can provide. As to how, exactly, anti-depressants, such as Duloxetine, work with pain is not yet fully understood. In the UK, Duloxetine is available on the NHS for diabetic related neuropathic pain. However, a GP/pharmacy/nurse/physiotherapist prescriber can also prescribe it for non-neuropathic pain as an unlicensed use. This is very common and perfectly routine. Other , older type, antidepressants known as tricyclics are also widely used for pain Mood stabilizers and drugs used for epilepsy can also be used Prisons are awash with gabapentin and pregabalin and a lot of pressure is put on prison medical teams and community GPs to prescribe these items. Clearly, when, these drugs were invented and marketed the abuse and addiction potential was not realized: The same could be said about benzodiazepines. What is clear, from my experience with patients dependent on these medications, is that it can be a tough ride to come off and needs to be done in a safe, supervised and supportive environment. What Is Pregabalin? To understand its abuse as a drug, it’s important to first understand what pregabalin is and what its purpose is. Pregabalin is an anticonvulsant drug, meaning it is part of a class of drugs that is used primarily for epileptic seizures and can also be used for managing some mental health disorders as well as neuropathic pain. Other such anticonvulsant drugs are carbamazepine, oxcarbazepine (Trileptal or Oxtellar XR), and valproic acid . Pregabalin comes in several forms, including capsules, oral solutions, and long-acting tablets. Depending upon the patient, any of these may be prescribed by a doctor to help them handle neuropathic pain primarily in the limbs. Spinal cord injuries and fibromyalgia are also prime targets of pregabalin treatment, as it helps the body to reduce the number of pain signals that are emitted from its damaged nerves. Since 2004, pregabalin has been prescribed for millions of people under the brand name Lyrica (and Lyrica CR) to aid them in dealing with these issues and symptoms.

It is vital that patients who are prescribed pregabalin use it exactly as directed by their doctor. This will help to ensure that the risks associated with the drug are minimized, and it will increase the chance that the patient will benefit from it in the long run. Because pregabalin (similar to many other drugs) interacts with other substances in varying ways, it’s important that you tell your doctor what else you are currently taking before you get a prescription for it. This includes both more powerful substances such as psychoactive drugs and more mild supplements such as vitamins, herbal products, and nutritional supplements.

Side Effects Pregabalin can cause a wide variety of side effects, some more severe than others. Some of the more mild side effects are fatigue, nausea, headaches, dry mouth, bloating, increased gas, and constipation. It can also have more unusual side effects such as:

  • Dizziness
  • Feeling high
  • Uncontrollable shaking or twitching
  • Forgetfulness
  • Speech problems
  • Appetite increase

The side effects of pregabalin can vary significantly from person to person, so it’s important to proceed with the drug carefully and watch for the development of any of these symptoms. There are also more extreme side effects that may occur, including the following:

  • Eyesight changes
  • Swelling throughout the body
  • Wheezing and shortness of breath
  • Muscle or chest pain
  • Extreme fatigue
  • Confusion
  • Blue-tinted skin

If you experience any of these more serious side effects, you need to call your doctor immediately and get instructions on how to proceed.

In addition to these side effects, other potential risks have been found associated with taking pregabalin. Some of these include developing aggression, causing birth defects, and experiencing a decrease in fertility for men.

Due to these many potential side effects and other risks of pregabalin, it is imperative that anyone prescribed this medicine follow through on all subsequent appointments with their doctor as well as closely follow their doctor’s instructions for taking pregabalin. By keeping appointments, you can help your doctor follow up on your health and, in the process, potentially catch on to issues you may have missed.

Though they have great potential for good when used correctly, powerful drugs like pregabalin must be prescribed and taken with care. Furthermore, if an allergic reaction is experienced as a result of taking pregabalin, a different drug should be prescribed for the patient in question. Pregabalin Abuse and Its Dangers Pregabalin abuse occurs when the drug is taken without the approval of a prescribing doctor, when taken in excess, and when taken despite significant side effects that may become harmful. While pregabalin is not usually the first drug that one thinks of in relation to drug abuse, it can be abused and become harmful. Its interactions with other drugs need to be kept in mind and monitored. Addiction to pregabalin is possible and can cause physical and psychological issues that interfere with your health and quality of life. And the withdrawal symptoms associated with the drug are also important to be aware of.

Drug Interactions If drugs are already being taken to treat, depression or anxiety, the effects can become intensified by the added use of pregabalin. This, in turn, can cause a lack of judgment on the user’s part and lead to risky decision-making.

Pregabalin has also been jokingly dubbed “Budweiser” in reference to its ability to make someone feel drunk, so needless to say its combination with alcohol (which is a depressant and affects judgment) is dangerous in the same way.

Pregabalin has been used to enhance the effects of heroin (a much more powerful drug that is often abused). When combining these two drugs, overdose is a danger as well as experiencing a blackout. Heroin is already a particularly dangerous drug (classified as a Schedule I substance), and adding anything to it will only make its effects worse and potentially more unpredictable. When combined with any of a wide variety of other drugs, the risk of experiencing the side effects of pregabalin increases. This includes its combination with thiazolidinediones such as pioglitazone (Actos) and rosiglitazone (Avandia), opioids such as tramadol (Ultram) and methadone (Methadose), and benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin). Sleeping drugs of various kinds can also increase the risk of experiencing side effects from pregabalin.

Currently, pregabalin is not known to interact in any harmful way with SSRIs such as escitalopram. However, both types of drugs can increase the risk of bleeding, so when pregabalin is prescribed, the prescribing doctor needs to know if both will be taken at the same time.

Addiction The most significant danger of pregabalin abuse is the development of an addiction to it. Pregabalin, as a type V substance, is not particularly addictive, but that doesn’t mean dependence on it isn’t possible. Its relaxing effects can become a crutch for users, especially those with chronic pain. It also produces something of a gentle high, and as a result, it is easy for users to underestimate its addictive nature over time. Psychological dependence on pregabalin is especially of concern for those with a prior history of drug abuse or addiction.

There isn’t necessarily a known component of pregabalin that is particularly responsible for its addictive effects. The calming and relaxing feelings it provides are enough to sometimes cause users to depend on it more than they should. Those who are in especially stressful jobs or life situations need to be especially on guard against developing a dependence on and addiction to pregabalin.

Addiction can lead to fatalities, and the number of deaths associated with pregabalin increased significantly during the early and mid-2010s. These fatalities should give one pause for thought before abusing a drug like pregabalin.

Withdrawal Symptoms

Pregabalin abuse is also dangerous because of the withdrawal symptoms that can be experienced when the drug wears off. Some of these withdrawal symptoms are physical, while others are emotional and psychological.

Physical symptoms of withdrawal from pregabalin include headaches, nausea, high heart rate, digestive problems, sweating, seizures, and insomnia. Withdrawal can also manifest in changes in mood, general agitation, anxiety, depression, and confusion.

The emotional withdrawal symptoms associated with drug abuse are often missed until after the physical withdrawal symptoms fade, but they can be just as difficult to cope with. That’s why it’s important to navigate your emotions with the help of a supportive network and community around you when detoxing from a drug. Without help from others, relapsing into taking the drug again, whether pregabalin or something else, becomes much more likely. Identifying Pregabalin Abuse One easy way to know that pregabalin is being abused is if the user does not have a prescription for it in the first place. Because of its potential side effects and addictive qualities, it should never be taken without the oversight and direction of a prescribing doctor who can follow up and monitor its effects over time.

However, pregabalin can also be abused by those who have been prescribed this medication. To understand whether a person is abusing it, there are several questions you can ask about the situation, such as:

  • The drug is no longer working but continues to be taken
  • The patient routinely misses doctor appointments and follow-ups
  • The patient has tried without success to ease off of dosages of the drug
  • The drug is being used in tandem with another drug (especially illegal drugs and alcohol)
  • Withdrawal symptoms are increasing over time

If any of these rings true for you or someone you know, there is a good chance that pregabalin abuse is occurring and intervention is needed. It’s important to note that pregabalin is also sold on the black market for those who want the drug but are unable to obtain it legitimately through a prescription. Therefore, it is possible for a friend or loved one to have possession of it even if they haven’t seen a doctor or received a prescription recently. Unfortunately, pregabalin also doesn’t typically show up on drug test results, so it is relatively easy for students and workers alike to get away with abusing it.

If you know of someone abusing pregabalin, it’s important that you not underestimate the damage it could do to them physically, mentally, and emotionally. Encourage them to seek professional help and find a healthy way to cope. Treatment for Pregabalin Abuse There are many aspects of a good treatment for any drug abuse, including the abuse of pregabalin. One of the most important aspects of any good treatment plan is the involvement of professional doctors and therapists who can join the patient in their fight against drug addiction. Another extremely important aspect is the presence of close family and friends to support and help in whatever ways are most appropriate for the patient. With this kind of support system in place, the detox and rehab process have a much greater chance of being successful in the life of the patient.

Medical Detox A medical detox is the process of allowing the pregabalin to leave the body’s system even while aiding the patient with other forms of medical care (including alternative medication) in order to alleviate withdrawal symptoms while they transition. Inpatient detox programs are particularly helpful because the patient will receive professional help from the beginning of the detox until the end.

For some patients, the detox process may only take a couple of days. Typically, that’s how long the withdrawal symptoms for pregabalin will last. But for others, certain symptoms may persist for much longer, so every patient needs to have their detox tailored to them and be prepared to do what it takes to see the process through.

The staff involved in the medical detox should be able to make recommendations to the patient and their family about steps to take following the detox. These steps can include anything from finding a rehabilitation center that can offer a more holistic process of recovery to finding a professional therapist who can help the patient get to the bottom of some of the issues hidden at the root of the drug abuse.

Rehabilitation Programs Once the detox has been completed, it is advisable for recovering pregabalin users to find a strong rehab program near them that can help prepare them for long-term sobriety and equip them with the tools they need to live productively and return to normal. The family of the patient should be involved in this decision, but it’s vital that the patient themselves understand the importance of such rehabilitation for their own part.

Rehab programs may incorporate any or all of the following elements that can help the recovering addict move forward:

  • Lectures and similar teaching resources about the nature of addiction and dependency
  • Work with a 12-step program
  • Cognitive behavioral therapy
  • Other specialized therapy
  • Relapse prevention measures
  • Training for life skills (such as career coaching)
  • Physical health resources such as dieting and exercise
  • Daily calendaring for consistency
  • Family involvement in the process

Some programs are inpatient while others are outpatient. Both options are helpful in their own ways, and each person must weigh them with the counsel of their family and medical professionals to make the best decision.

There are also sober living programs that can help to bolster a person’s recovery. They provide gender-specific housing that is designed for people recovering from drug addiction, and they can be a great resource for someone getting back on their feet after a pregabalin addiction. These sober living programs may be especially helpful for those who don’t have any family living near them.

Aftercare programs are also offered, which allow those who go through rehab to follow up with professionals, and fellow people in recovery alike, on a regular basis to maintain a network of support as they continue in life. This can be especially helpful for those who feel that no one understands their experience as an addict, and it can provide an opportunity for former pregabalin abusers to discuss the highs and lows of their journey to sobriety.

Counseling and Therapy Professional counseling and therapy may also be an important aspect of treatment after pregabalin abuse. Therapy (such as cognitive behavioral therapy or talk therapy) can help a patient get to the bottom of the emotional factors that may have driven their addiction in the first place. As a result, patients can receive more thorough treatment and can be better equipped for long-term freedom.

When finding a therapist or counselor to meet with, it’s important to keep in mind the credentials and expertise of any given professional. There are plenty of therapists out there who are excellent in what they do but do not treat addiction, so be sure to find a therapist who is experienced in this area of mental health for the best results possible. Find Help When You Need It As with any substance abuse or addiction issue, finding healing and freedom is a process that can take time. It isn’t a quick fix or easy solution, but proper treatment and rehabilitation will equip you with the tools you need to get your life back and live to the fullest. Counseling and therapy can also be a big part of that long-term success for the patient. If you or someone you know is struggling with pregabalin abuse or any other drug abuse or addiction, get the professional help that is needed right away. Contact me to find out how I can connect you and those you care about with the right care and treatment. Doing so can make the world of a difference for both you and your loved ones.

Easy to start, not so easy to stop!
Gabapentin and Pregabalin