Pregabalin (brand name Lyrica) and gabapentin (brand name Neurontin and others) are two closely related medications that make up the drug class known as “gabapentinoids.” They were initially developed as anti-seizure medications or “anticonvulsants,” but have found much wider use for other purposes, particularly for “neuropathic” pain.

Neuropathic pain is the type of pain that results from diseases or injuries to sensory nerves. Diseases that target the nerves – such as diabetes, HIV and shingles – can cause a specific type of pain that can be intense and does not respond to traditional pain medications like opioids and anti-inflammatories.

Pregablin and gabapentin prescriptions for pain are on the rise:

  • In 2016, 64 million prescriptions for Lyrica were dispensed in the U.S., up from 39 million in 2012
  • In 2016, Lyrica sales were $4.4 billion in the U.S., more than twice that of 2012
  • In 2016, Lyrica ranked 8th in the U.S. for drug spending
  • In 2016, gabapentin was the 10th most commonly prescribed medication in the U.S.

What Are Lyrica & Gabapentin Used For?

Lyrica and gabapentin are FDA-approved for four pain uses:

  1. Postherpetic neuralgia (PHN): pain that appears before, during or after having shingles (Lyrica and gabapentin)
  2. Fibromyalgia (Lyrica only)
  3. Neuropathic pain associated with spinal cord injuries (Lyrica)
  4. Neuropathic pain associated with diabetes (Lyrica)

Lyrica and Neurontin are also used for the treatment and prevention of certain types of seizures.

  • Gabapentin Off-Label Uses:

    • Restless legs syndrome
    • Cocaine withdrawal, alcohol withdrawal
    • Insomnia
    • Diabetic neuropathy
    • Tremors in multiple sclerosis (MS)
    • Cancer-related hot flashes
    • Certain types of anxiety

  • Lyrica Off-Label Uses:

    • Certain types of anxiety
    • Insomnia

There have been significant concerns raised about the overprescribing of these medications due to clinicians using them for almost any type of pain. This is partly in response to the opioid crisis, which has made clinicians search for any available alternatives to prescribing opioid narcotics for pain. 

Similarities Between Lyrica & Gabapentin

Lyrica and gabapentin share a common chemical structure and a similar mechanism of action. They both have a similar side effect profile, similar reactions to other drugs, and they both have addiction potential.

Although Lyrica and gabapentin are not narcotics, they are increasingly being used to achieve a high. A 2015 study in a small area of Kentucky found that 15% of the people struggling with opioid addiction reported using gabapentin to get high, which represents a 165% increase from the year before and a 2,950% increase since 2008.

The addictive potential and the marked increase in concurrent opioid and Lyrica/gabapentin abuse are of particular concern. It appears that these drugs increase the risk of heroin overdose by either a reversal of tolerance or suppressed breathing, which is the primary mechanism by which opioids are fatal.

Although data on the abuse of gabapentin is preliminary, the FDA is actively looking into the dangers of gabapentin and how to better address them. In the meantime, these drugs should be used with great caution by people who are also taking opioids, and in people with a history of addiction or who are at high risk for addiction.

Side Effects of Lyrica & Gabapentin

  • Most Common Side Effects of Lyrica & Gabapentin:

    • Dizziness
    • Sedation/fatigue
    • Lack of coordination, unsteadiness, loss of balance
    • Shaking
    • Jerky movements
    • Visual problems: abnormal eye movements, double vision, blurred vision
    • Impaired speech
    • Impaired memory
    • Serious allergic reactions
    • Increase in suicidal ideation and behavior

    Lyrica has some additional common side effects:

    • Dry mouth
    • Constipation
    • Weight gain
    • Swelling in the extremities

Both medications can make it unsafe to operate machinery or drive a vehicle. They both should not be taken while using alcohol or other sedating drugs.

Withdrawal Effects of Lyrica & Gabapentin

Discontinuing either medication abruptly can cause seizures, so anyone considering lowering or stopping their dosage of Lyrica or gabapentin should do so only under the direction of a healthcare professional. Lowering the dose or discontinuing use must usually be done slowly.

  • Most Common Withdrawal Effects of Lyrica & Gabapentin:

    Lyrica and gabapentin have similar withdrawal effects:

    • Rapid heart rate (tachycardia)
    • Anxiety
    • Aggression and agitation (akathisia) – especially with Neurontin
    • Profuse sweating (diaphoresis)

    These withdrawal effects are part of the addictive properties of these drugs.

Differences Between Lyrica & Gabapentin

The major differences between the two medications lie in how they are absorbed after being taken orally:

  • Gabapentin is absorbed into the body more slowly than Lyrica is; gabapentin takes about three hours to reach peak levels versus one hour for Lyrica.
  • Lyrica is almost completely absorbed into the body, while gabapentin is not.
  • Gabapentin reaches a maximum level in the body, while Lyrica has no ceiling to absorption.
  • Gabapentin absorption is affected by food intake, while Lyrica is not.
  • Lyrica can be titrated to the correct dose in an average of 1-2 days, versus 9 days for gabapentin.

Lyrica is much more expensive than gabapentin, however, Lyrica is effective at much lower daily doses than gabapentin.

  • Lyrica vs. Gabapentin for Fibromyalgia

    Lyrica is also used to treat a type of chronic pain syndrome known as fibromyalgia (FM). The cause of the pain that occurs in people with FM is not known for sure, but it is almost certainly neuropathic.

    A 2018 Cochrane Review showed that gabapentin is grossly understudied for use in treating FM, with only one low-quality study identified in the review. The review concluded that there isn’t enough research to support or refute the use of gabapentin for treating FM.

    A 2016 Cochrane Review looking at Lyrica for FM showed that the drug provides a major reduction in pain intensity.

  • Lyrica vs. Gabapentin for Anxiety

    Both drugs have been found to be useful for treating generalized anxiety disorder (GAD). Although the research evidence is sparse, pregabalin and gabapentin have both been shown to be effective at improving the physical and psychological symptoms of GAD. However, the side effect profile, potential for abuse and presence of other more effective anxiety medications means that pregabalin and gabapentin are only reserved for people who have not responded adequately to first-line treatments.

    Gabapentin has a more favorable risk-to-benefit ratio than pregabalin for treating GAD, so it is the preferred drug for this type of treatment.

  • Lyrica vs. Gabapentin for Chronic Pain

    Lyrica and gabapentin are both used for treating neuropathic pain. Neuropathic pain is usually chronic since it is caused by lasting diseases or injuries. Lyrica and gabapentin are approved by the FDA for three specific types of neuropathic pain (PHN, spinal cord injuries, and diabetic neuropathy), but are often used for neuropathic pain of any origin.

    Neuropathic pain is characterized by symptoms such as:

    • Shooting, burning or lancinating pain
    • Associated numbness, tingling and/or pins-and-needles sensations
    • Spontaneous onset and exacerbation of pain with no obvious cause
    • Pain that is difficult to describe

    There are some differences between using Lyrica vs. gabapentin for chronic pain. A 2016 study examined the effects of Lyrica and gabapentin for an uncommon use: treating pain after gallbladder surgery. The study found both medications to be effective (superior to placebo), but Lyrica was superior in:

    • Reducing pain
    • Preventing the need for opioid pain medications
    • Reducing the amount of opioids taken

    Head-to-head studies comparing the effectiveness of Lyrica to gabapentin are sparse, but several study protocols for upcoming research projects on the subject have been published. In the meantime, a 2010 study suggested that Lyrica may provide better pain relief compared to gabapentin. However, at the present time, there is no substantial research evidence supporting the superiority of one drug over the other for treating chronic pain.

Taking Lyrica & Gabapentin Together

While gabapentin and Lyrica are usually used in combination with other medications, they should never be taken together. Once absorbed into the body, they are very close to being the same drug and can cause additive side effects and can be toxic.

Key Points: Lyrica vs. Gabapentin

The key points to remember about Lyrica and gabapentin are:

  • They are closely related drugs
  • They were developed as seizure medications but used extensively for treating pain
  • They should only be used for treating neuropathic pain until further studies are done
  • They both can be addictive
  • Both have serious potential side effects and should only be used under the direction and supervision of a licensed prescriber

If you think that you or someone you know may be abusing gabapentin or Lyrica, please feel free to contact us at The Recovery Village for a confidential discussion with one of our counselors. Our staff are experts at the diagnosis and treatment of substance use and co-occurring mental health disorders, and we are always available to help.