Abuse Potential of Pregabalin

Schjerning, Ole; Rosenzweig, Mary; Pottegård, Anton; Damkier, Per; Nielsen, Jimmi

doi:10.1007/s40263-015-0303-6

Cited by 130 publications

(94 citation statements)

References 74 publications

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“…Although pregabalin does not bind to GABA receptors and not associated with GABA activity, it has GABA-mimetic features which was shown in rats [2]. Over the therapeutic doses, sedation, dissociation, relaxation, pleasure, drowsiness, disinhibition, improved sociability, empathy or auditory and visual hallucinations may occur.…”

Section: Discussionmentioning

confidence: 99%

“…However, pregabalin is widely used for off-label conditions such as substance use disorders, alcohol withdrawal syndrome, restless legs syndrome, migraine and vasomotor symptoms of menopause [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…In Turkey, pregabalin is indicated for neuropathic pain, generalized anxiety disorder, fibromyalgia and partial epilepsy as add-on therapy at 150-600 mg/day doses. Euphoria is a frequent side effect of pregabalin and several cases of overdose from recreational use have been reported [1,2]. In the study of Zellner et al, seizure was defined as a rare intoxication symptom [3].…”

Section: Introductionmentioning

confidence: 99%

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Nasal pregabalin overdose and myclonus: a new way of misuse

Öztürk

Morkavuk

2018

Psychiatry and Clinical Psychopharmacology

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Pregabalin reduces central neuronal excitability and has gamma-aminobutyric acid-mimetic features, which was demonstrated in rats. Pregabalin is indicated for the treatment of neuropathic pain, post-herpetic neuralgia, fibromyalgia and partial seizures. However, pregabalin is widely used for off-label conditions. Euphoria is a frequent side effect of pregabalin and several cases of overdose from recreational use have been reported until recently. Our aim is to present a case of a patient with myoclonus after high dose nasal pregabalin misuse. A 23-year-old female patient presented to the emergency department with unconsciousness and involuntary movements in her arms. She used, 10-15 numbers of 300 mg pregabalin capsules by nasal inhalation for recreational purpose for the first time. Her vital signs were within normal limits. The patient's serum ethanol, drug and substance levels were negative. During the examination, myoclonus with 2-3 beats was occasionally observed in the upper extremities. Emergency brain computed tomography was normal. During the electroencephalography (EEG monitorization, one generalized spikewave activity was observed for a second. We started 800 mg valproic acid i.v. therapy and prescribed valproic acid 500 mg/day p.o. at discharge. One week after discharge, she had no myoclonic jerks even though she did not use the recommended antiepileptic drug. Control EEG was within normal limits. Pregabalin overdose was suggested to be relatively safe but myoclonic seizures should be taken into consideration as a side effect. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nasal pregabalin overdose and myclonus: a new way of misuse

Öztürk

Morkavuk

2018

Psychiatry and Clinical Psychopharmacology

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“…(and 12% in sub-populations) of subjects treated with pregabalin reported euphoria, and abrupt discontinuation of treatment was found to be associated with withdrawal symptoms (200).…”

Section: Pregabalinmentioning

confidence: 99%

“…However, the pre-marketing program led to conflicting conclusions regarding the abuse potential of pregabalin (200).…”

Section: Pregabalinmentioning

confidence: 99%

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Tjäderborn

2016

Linköping University Medical Dissertations

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Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognised and emerging public health concerns. Aim:The aim of this thesis is to estimate the occurrence and prevalence of psychoactive prescription drug use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods:A study using register data from forensic cause of death investigations analysed and described cases of fatal unintentional intoxications with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were scrutinized and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming intake of tramadol, diazepam, flunitrazepam, zolpidem and zopiclone, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a national cohort of patients initiating prescribed treatment with pregabalin, identified using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use above the maximum approved daily dose (MAD) of the drug, and factors associated with the utilisation patterns (Study IV).Results: In the first study, 17 cases of unintentional intoxications were identified, in which tramadol was judged to have caused or contributed to the death. Of the deceased, more were men, the median age was 44 years and the majority used multiple psychoactive substances (prescription drugs, alcohol and/or illicit drugs). In the second study, 104 spontaneously vi reported cases of possible or probable tramadol dependence were identified, of which more concerned women. The median age in these cases was 45 years and in about a third of cases the person had a history of substance abuse and in 40% of cases there was documented history of psychoactive medication use. Severe addiction was reported. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription.Non prescribed use was most frequent in users of benzodiazepines and of tramadol compared to users of zolpidem or zopiclone, and was more likely in younger individuals and in multiplesubstance users and less likely in individuals with a recent prescription for another psychoactive medication. In the last paper, five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of use of doses above the maximum approved daily dose. The highest risk of use of daily doses above the MAD over time was associated with male sex, younger age, non-urban residency, and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions

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Pregabalin for neuropathic pain in adults

Derry¹,

Bell

Straube

et al. 2019

Cochrane Database of Systematic Reviews

221

189

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Background This review updates part of an earlier Cochrane Review titled "Pregabalin for acute and chronic pain in adults", and considers only neuropathic pain (pain from damage to nervous tissue). Antiepileptic drugs have long been used in pain management. Pregabalin is an antiepileptic drug used in management of chronic pain conditions. Objectives To assess the analgesic efficacy and adverse effects of pregabalin for chronic neuropathic pain in adults. Search methods We searched CENTRAL, MEDLINE, and Embase for randomised controlled trials from January 2009 to April 2018, online clinical trials registries, and reference lists. Selection criteria We included randomised, double-blind trials of two weeks' duration or longer, comparing pregabalin (any route of administration) with placebo or another active treatment for neuropathic pain, with participant-reported pain assessment. Data collection and analysis Two review authors independently extracted data and assessed trial quality and biases. Primary outcomes were: at least 30% pain intensity reduction over baseline; much or very much improved on the Patient Global Impression of Change (PGIC) Scale (moderate benefit); at least 50% pain intensity reduction; or very much improved on PGIC (substantial benefit). We calculated risk ratio (RR) and number needed to treat for an additional beneficial (NNTB) or harmful outcome (NNTH). We assessed the quality of the evidence using GRADE. Main results We included 45 studies lasting 2 to 16 weeks, with 11,906 participants-68% from 31 new studies. Oral pregabalin doses of 150 mg, 300 mg, and 600 mg daily were compared with placebo. Postherpetic neuralgia, painful diabetic neuropathy, and mixed neuropathic pain predominated (85% of participants). High risk of bias was due mainly to small study size (nine studies), but many studies had unclear risk of bias, mainly due to incomplete outcome data, size, and allocation concealment. Postherpetic neuralgia: More participants had at least 30% pain intensity reduction with pregabalin 300 mg than with placebo (50% vs 25%; RR 2.1 (95% confidence interval (CI) 1.6 to 2.6); NNTB 3.9 (3.0 to 5.6); 3 studies, 589 participants, moderate-quality 1 Pregabalin for neuropathic pain in adults (Review)

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Abuse Potential of Pregabalin

Abstract: Overall, the available literature suggests an important clinical abuse potential of pregabalin and prescribers should pay attention to signs of abuse, especially in patients with a history of substance abuse.

Cited by 130 publications

References 74 publications

Nasal pregabalin overdose and myclonus: a new way of misuse

Nasal pregabalin overdose and myclonus: a new way of misuse

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Pregabalin for neuropathic pain in adults

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