Pregabalin (Lyrica)
Anticonvulsant (glutamate alpha-2 delta calcium channel blocker)
- Generalized Anxiety Disorder1
- Social Anxiety1
- Benzo withdrawal3
- Alcohol use disorder3
- OCD3
- Neuropathy
- Fibromyalgia (FDA approved)
- Restless leg syndrome3
- Deepens sleep quality
Features
Dosing
Anxiety: Start 150 mg qhs, titrate every 3-7 days to 300-600 mg/night.
Similar dosing for fibromylagia and pain.
Controlled substance in some states.
INTERACTIONS: Synergestic respiratory depression with benzos, alcohol, opioids.
Management
TOLERABILITY: Dizziness, weight gain, sedation.
RISKS: Respiratory depression (with other sedatives), edema.
EMR Text
Generalized and Social Anxiety Disorder
Pregabalin use based on large, randomized controlled trials in anxiety disorders, including social and generalized anxiety disorder (Cardoner N et al, Front Pharmacol. 2025;16:1483770; Kawalec P et al, Expert Opin Investig Drugs. 2015;24(4):585-594).
Pregabalin side effects reviewed with patient.
Benzo WD
Pregabalin use based on controlled trials in benzodiazepine withdrawal, where it improved anxiety and may also improve sleep quality (Hadley SJ et al, J Psychopharmacol. 2012;26(4):461-470).
Pregabalin side effects reviewed with patient.
Alcohol Use Disorder
Pregabalin use based on controlled trials in alcohol use disorder and potential to improve sleep, anxiety, and sobriety (Krupitsky EM et al, Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(1):33-43).
Pregabalin side effects reviewed with patient.
OCD
Pregabalin use based on a small, randomized controlled trial in OCD (Mowla A, CNS Spectr. 2020;25(4):552-556).
Pregabalin side effects reviewed with patient.
Anxiety in Bipolar
Pregabalin use based on studies suggesting efficacy of the gabapentinoids for anxiety in bipolar disorder (Hong JSW et al, Mol Psychiatry. 2022;27(3):1339-1349).
Pregabalin side effects reviewed with patient.
Restless leg syndrome
Pregabalin use based controlled trials in restless leg syndrome (Garcia-Borreguero D et al, Sleep. 2014;37(4):635-643).
Pregabalin side effects reviewed with patient.
Fibromyalgia and Pain
Pregabalin use based on FDA approval in pain conditions, including fibromyalgia and neuropathy.
Pregabalin side effects reviewed with patient.