Gabapentin and Lyrica for Pain Control

Medically Reviewed by Poonam Sachdev on October 18, 2022
4 min read

Gabapentin (Neurontin) and pregabalin (Lyrica) both belong to a class of drugs called gabapentinoids, which means they work in similar ways. They're both used to treat chronic pain in certain conditions. They're often prescribed by doctors because they are an alternative to opioids and are thought to be safer. However, there are some significant risks associated with using gabapentin, pregabalin, and both medicines together. When you're comparing gabapentin versus Lyrica, you should consider the benefits and risks. 

Gabapentin is used to treat partial seizures that occur with epilepsy and nerve pain resulting from nerve damage such as: 

  • Postherpetic neuralgia, a type of nerve pain caused by shingles
  • Diabetic neuropathy, a burning pain in the feet caused by nerve damage from diabetes

Gabapentin is prescribed for long-term pain control. It isn't used to treat short-term pain. Researchers aren't sure exactly how it works, but it may change how your body feels and reacts to pain. Gabapentin may take up to four weeks to reach maximum effect. It's usually started at a low dose and increased gradually until it starts working. 

Gabapentin doesn't work for everyone. About 30 to 40% of people who take gabapentin can reduce their pain by half. However, up to 60% of people don't experience pain relief but do have side effects. 

Gabapentin side effects. Gabapentin can cause side effects such as: 

  • Sleepiness
  • Dizziness
  • Water retention
  • Clumsiness while walking
  • Jerky movements
  • Increased risk of infection
  • Difficulty speaking
  • Unusual eye movements

Pregabalin is also used to treat nerve pain. It's often prescribed to people whose nerve pain hasn't improved with other medicines. Pregabalin may help reduce the pain you feel by changing your brain chemicals that send pain messages to your nerves. It doesn't work immediately, and your doctor will gradually increase your dose until effective levels are reached. However, not everyone responds to pregabalin. So, you'll need to monitor your results.  

Lyrica side effects. Pregabalin should not be taken with some medications. So, make sure your doctor knows all the medicines and supplements you're taking. If you've had kidney disease, you should also tell your doctor because they may need to adjust your dose. Pregabalin can cause side effects in some people: 

  • Drowsiness
  • Dizziness
  • Possible worsening of symptoms of depression
  • Possible increase in suicidal thoughts for people with depression 
  • Getting dizzy and drowsy when pairing alcohol with pregabalin

Gabapentin and pregabalin belong to the same class of medicines — gabapetinoids. So, there are a lot of similarities between them. They both work in a similar way, although researchers aren't sure exactly how. They may bind to certain nervous system pathways to change how your brain senses pain. Similar side effects have been reported with both medicines, and both can cause withdrawal syndromes if you stop them too suddenly. 

However, there are some significant differences between gabapentin and pregabalin. They are not interchangeable. So, you can't just switch one for another without your doctor's approval. Pregabalin is more likely to cause some side effects, including: 

  • Dry mouth
  • Constipation
  • Swelling
  • Weight gain
  • Enlarged breasts 

Gabapentin is more likely to cause different side effects from pregabalin, including: 

  • Fever
  • Increased risk of infection
  • Difficulty speaking
  • Jerky movements
  • Unusual eye movements

Pregabalin is absorbed into your system faster. Within an hour of taking pregabalin, it reaches its maximum concentration. Because of its faster absorption rate, pregabalin may be more addictive. Gabapentin takes three to four hours to reach maximum concentration.

Normally, medicines that are very similar, such as gabapentin and pregabalin, aren't used together because they act similarly. However, some studies have shown that prescribing lower doses of gabapentin and pregabalin together may work better than prescribing higher doses of just one. You may also experience fewer side effects since you'll be taking lower doses of each medicine. Combining both gabapentin and pregabalin may be a good option for people who can't tolerate a higher dose of one medicine, such as older patients with kidney damage. However, more research needs to be done since these were small studies. 

Right now, most people are only prescribed one medicine. Whether your doctor prescribes gabapentin or pregabalin will depend on different factors, such as why you need it, how much it costs, and if there are reasons you shouldn't take one or the other. 

The FDA issued a warning that serious risks are associated with using gabapentin and pregabalin if you have a respiratory condition. Some people with respiratory risk factors may have serious breathing difficulties if they take gabapentin or pregabalin. These risks are associated with both generic and brand-name medicines. Brand names for gabapentin include: 

  • Neurontin
  • Gralise
  • Horizant

Brand names for pregabalin include:  

  • Lyrica
  • Lyrica CR

Respiratory risk factors that could increase your chances of having breathing difficulties with gabapentin and pregabalin include: 

  • Using opioids or other medicines that reduce the activity of your central nervous system, such as anti-anxiety medicines, antidepressants, and antihistamines
  • Chronic obstructive pulmonary disease or other conditions that reduce your lung function
  • Being older

As per FDA, along with the other information, you should know about these risks when you are given gabapentin or pregabalin. The FDA also wants the drug companies to conduct further studies to find out what happens if you abuse both the medicines, especially the risk of breathing problems. 

To help reduce the risks associated with taking either gabapentin or pregabalin, you should always let your healthcare provider know about all of the medicines you're taking, including prescription and over-the-counter medicines. You should also talk to your health care provider about other substances you use, such as alcohol. 

Seek immediate medical attention if you're taking gabapentin or pregabalin and experience any of the following symptoms: 

  • Disorientation
  • Confusion
  • Unusual lightheadedness or dizziness
  • Severe sleepiness or lethargy
  • Difficulty breathing or slowed, shallow breathing 
  • Inability to respond normally or wake up when called loudly
  • Blue-tinged skin, especially on your lips, fingers, or toes