What is Lyrica? Uses, Side Effects, and Abuse

Lyrica or pregabalin is a medication that is classified as an anticonvulsant. While used to treat partial onset seizures or epilepsy, it has also been FDA approved to treat neuropathic pain caused by damaged nerves, diabetes, shingles and fibromyalgia.

It works by slowing down impulses in the brain that can cause seizures and decreases the release of certain brain chemicals that send pain signals to the brain via the nervous system.

Although Lyrica has become a commonly prescribed medication for pain, it is not an opioid.

Lyrica crosses the blood brain barrier, attaching to presynaptic voltage-gated calcium channels and decreasing certain neurotransmitters in the brain that help to block pain signals, whereas opioid drugs bind to opioid receptors, reducing the transmission of pain signals and altering the perception of pain.

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What is Lyrica Used For?

Lyrica is FDA approved in the United States to treat pain associated with damaged nerves, diabetes, shingles and fibromyalgia.

It binds to areas of the central nervous system to decrease nerve impulses and decreases the release of certain neurotransmitters in the brain. It is also used, along with other medications, to treat epilepsy and partial onset seizures by slowing down impulses in the brain that cause seizures.

In addition to the FDA-approved conditions, Lyrica is also being used “off label” to treat other conditions. The term off label means that the drug is being used to treat conditions other than the ones it was originally designed for.

These off label conditions include generalized and social anxiety disorder, insomnia, chronic pain conditions, uremic pruritus, chronic cough, complex regional pain syndrome, trigeminal neuralgia and to prevent migraine headaches.

Lyrica is considered a first-line drug in the treatment of neuropathic pain, often in conjunction with other drugs such as gabapentin. For individuals who use it off label, it is generally prescribed after first-line drugs have been tried without success.

Lyrica vs. Gabapentin

While both Lyrica and gabapentin are considered gabapentinoids and are often used to treat the same conditions and have similar side effects, there are distinct differences between the two drugs. Lyrica is considered a controlled medication on the Drug Enforcement Administration (DEA) Schedule of medications and illicit substances.

Gabapentin has not been placed on the federal Schedule of drugs; however, some states voluntarily consider it a Schedule 5 drug and require prescribers to follow monitoring and guidelines for use when it is prescribed.

Lyrica is absorbed more quickly than gabapentin, and regardless of the dose, the amount of drug remains bioavailable and stable in the body. The half life of gabapentin is between five and seven hours, whereas the half life of Lyrica is 6.3 hours.

Half life refers to the amount of time it takes for the plasma concentration of the drug to be reduced by 50% of its original value. Lyrica, therefore, remains in the body for about 35 hours, although its effect will wear off before that time. Gabapentin, however, takes 48 hours to clear the body and may need one to two weeks to reach the desired effects.

Both medications are highly effective in treating pain and preventing seizure activity. It is critical to remember that both have a potential for abuse and dependence and should be used with caution.

Is Lyrica Addictive or a Controlled Substance?

Lyrica is considered a controlled medication on the DEA Schedule of medications and illicit substances. It has been rated a Schedule 5 drug, which means it is a controlled substance with a low potential for abuse and has an accepted medical use in the U.S.

When compared to opioid drugs such as morphine or hydrocodone, which are considered Schedule 2 drugs, the potential for addiction is much lower with Lyrica.

For some people, the use of Lyrica induces a state similar to being drunk; others describe a feeling of euphoria when taking it, all of which can contribute to the potential for abuse and dependence. The risk is significantly higher when an individual has a prior history of addiction, especially opioid addiction.

Lyrica Side Effects and Withdrawal Symptoms

Lyrica has been shown to decrease pain and prevent seizures; however, its use is not without side effects.

The most common pregabalin side effects include:

• Dizziness
• Chills
• Fast heart beat
• Nausea
• Cough
• Sore throat
• Diarrhea
• Red, irritated eyes
• Weight gain

Serious side effects of pregabalin use include:

• Allergic reactions or angioedema
  • Skin rash; itching; hives; swelling of face, eyes, lips, tongue, arms or legs; trouble swallowing or breathing
• Vision problems
• Blue-colored skin, lips, fingers and toes
• Skin sores
• Easy bruising or unusual bleeding
• Feelings of depression or suicidal thoughts
• Breathing problems
• Confusion, extreme drowsiness or weakness
• Unexplained muscle pain, tenderness or weakness, especially when combined with feeling unwell or with a fever.

Individuals who have developed a psychological and/or physical dependence to Lyrica may start to exhibit Lyrica withdrawal symptoms as soon as 24 hours after the last dose. Symptoms can range from mild to severe and can last for one to two days.

A person may have residual Lyrica withdrawal symptoms for several weeks. The severity of withdrawal symptoms may increase with higher doses of the drug and increase when taken for longer periods.

Symptoms of pregabalin withdrawal include:

• Headaches
• Mood changes
• Agitation
• Depression
• Anxiety
• Confusion
• Suicidal thoughts
• Nausea
• Sweating
• Diarrhea
• Increased heart rate
• Cravings for the medication
• Insomnia
• Seizures
• Excessive sweating
• Flu-like symptoms such as feeling ill, muscle pain and fatigue

Abruptly stopping Lyrica is not recommended and can have serious consequences if not tapered over an extended period. Doses should not be adjusted without medical supervision.

Lyrica in Addiction Treatment: Risks and Benefits

The use of Lyrica in people with active addiction or a history of addiction should occur with extreme caution due to the risk of developing an addiction to the drug.

However, there are some arguments for its use in reducing withdrawal symptoms associated with benzodiazepine and opioid dependence. As well, the use of Lyrica has been shown to decrease pain associated with fibromyalgia and neuropathic pain, preventing the use of other highly addictive medications.

Arguments against the use of Lyrica in individuals who abuse other substances, especially opioids, are based on the potential for exacerbated withdrawal symptoms. This could lead to continued use to avoid the discomfort associated with discontinuing the drugs. There is also an increased risk of overdose when combined with other substances.

Overdose on Lyrica is rare, but it can happen, resulting in reduced consciousness, confusion, agitation, depression, anxiety and restlessness. When pregabalin is used with other central nervous system depressants, the result could include heart block, seizures and death.

One study published in Addiction, a peer reviewed journal of the Society For The Study of Addiction, found that when Lyrica is combined with opioid drugs such as heroin, it potentially increases the risk of acute overdose death.

The bottom line: Lyrica offers many therapeutic benefits, especially in chronic neuropathic pain or in preventing seizure activity. However, it should be used with caution due to the risk of addiction and overdose potential when combined with other drugs such as opioids and benzodiazepines.