Pregabalin - Brand names: Alzain, Axalid, Lyrica

Pregabalin is used to treat epilepsy and anxiety.

It's also taken to treat nerve pain. Nerve pain can be caused by different conditions including diabetes and shingles, or an injury.

Pregabalin works in different ways:

• in epilepsy it stops seizures by reducing the abnormal electrical activity in the brain
• with nerve pain it blocks pain by affecting the pain messages travelling through the brain and down the spine
• in anxiety it stops your brain from releasing the chemicals that make you feel anxious

Pregabalin is only available on prescription. It comes as capsules, tablets, or a liquid that you swallow.

• You'll usually take pregabalin 2 or 3 times a day. You can take it with or without food.
• Pregabalin is often used for epilepsy, but you can also take it to help with pain or anxiety if you do not have epilepsy.
• It takes at least a few weeks for pregabalin to work.
• The side effects of pregabalin are usually mild and go away by themselves. The most common ones are feeling sleepy, dizziness and headaches.
• If you have epilepsy it's important to take pregabalin regularly. Missing doses could trigger a seizure.

Pregabalin is only suitable for adults. It might not be suitable for people older than 65. Do not give it to children under 18.

Pregabalin is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

• have ever had an allergic reaction to pregabalin or any other medicine
• have ever abused or been addicted to a medicine
• are trying to get pregnant, already pregnant or breastfeeding
• are on a controlled sodium diet, or your kidneys do not work well – some brands of pregabalin liquid contain sodium, so speak to your pharmacist or doctor before taking it
• have any problems that affect your breathing

Pregabalin is a prescription medicine. It's important to take it as instructed by your doctor.

Dosage

The usual dose of pregabalin is between 150mg and 600mg a day, split into 2 or 3 separate doses.

If you are taking pregabalin as a liquid, 2.5ml is usually the same as taking a single 50mg capsule. Always check the label.

How to take it

You can take pregabalin with or without food, but it's best to take it in the same way each day. Try to space your doses evenly through the day.

Swallow pregabalin tablets or capsules whole with a drink of water or juice. Do not chew them.

If you are taking pregabalin as a liquid, it will come with a syringe or spoon to measure your dose. If you do not have a measuring spoon or syringe, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

How long to take it for

If you have epilepsy, it's likely that once your condition is under control you will continue to take pregabalin for many years.

If you're taking pregabalin for nerve pain or anxiety it's likely that once your symptoms have gone you will continue to take it for several months to stop them coming back.

Changes to your dose

To prevent side effects, your doctor will prescribe a low dose to start with and then increase it over a few days.

Once you find a dose that suits you, it will usually then stay the same.

If you forget to take it

If you forget a dose, take it as soon as you remember. If it's within 2 hours of your next dose, skip the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you have epilepsy, it's important to take this medicine regularly. Missing doses may trigger a seizure.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking too much pregabalin may cause unpleasant side effects.

Like all medicines, pregabalin can cause side effects although not everyone gets them.

Common side effects

These common side effects may happen in more than 1 in 100 people. They are usually mild and go away by themselves.

Keep taking the medicine but tell your doctor if these side effects bother you or do not go away:

• headaches
• feeling sleepy, tired or dizzy
• diarrhoea
• mood changes
• feeling sick
• swollen hands, arms, legs and feet
• blurred vision
• difficulties with getting an erection
• weight gain – because pregabalin can make you feel hungry
• memory problems

If you have diabetes, pregabalin can upset your blood sugar control. Monitor your blood sugar more often for the first few weeks of treatment with pregabalin and adjust your diabetes treatment if you need to. Talk to your doctor or diabetes nurse if you want more advice on what to do.

Serious side effects

Very few people taking pregabalin have serious problems.

Call a doctor or call 111 straight away if you get:

• thoughts of harming or killing yourself – a small number of people taking pregabalin have had suicidal thoughts, sometimes after only a week of treatment
• severe dizziness or you pass out
• hallucinations (seeing or hearing things that are not real)
• problems going to the toilet, including blood in your pee, needing to pee more often, or constipation

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to pregabalin.

Long-term side effects

Some people can become addicted to pregabalin.

If this happens, you'll have withdrawal symptoms after you stop taking the medicine.

When you stop taking pregabalin, you'll need to reduce your dose gradually to avoid withdrawal symptoms. Do not stop taking pregabalin without talking to your doctor.

You can also talk to your doctor if you're concerned about becoming physically dependent on pregabalin.

Other side effects

These are not all the side effects of pregabalin. For a full list see the leaflet inside your medicines packet.

What to do about:

• headaches – make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking pregabalin. Talk to your doctor if they last longer than a week or are severe.
• feeling sleepy, tired or dizzy – do not drive, cycle or use machinery until you feel better. As your body gets used to pregabalin, these side effects should wear off. If they do not wear off within a week or 2, your doctor may reduce your dose or increase it more slowly. If that does not work you may need to switch to a different medicine.
• diarrhoea – drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Check the pill packet for advice. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. If you take the combined contraceptive pill or progestogen-only pill and you have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy.
• mood changes – if you feel this medicine is causing mood changes, speak to your doctor as you may need a change of medicine.
• feeling sick – take pregabalin with or after a meal or snack to ease your symptoms. It may also help if you avoid rich or spicy food.
• swollen hands, arms, legs and feet – if your feet are swollen, try sitting with your feet up on a chair or bed and try not to stand for a long time. Exercise might help if your arms are swollen. If that does not help or it becomes painful, contact your doctor.
• blurred vision – do not drive, cycle or use tools or machinery while this is happening. If it lasts for more than a day or 2 speak to your doctor as they may need to change your treatment.
• difficulties with getting an erection – speak to your doctor, as they may be able to change your medicine or offer other treatments that might help with this problem.
• weight gain – pregabalin can make you hungrier so it can be quite a challenge to stop yourself putting on weight. Try to eat well without increasing your portion sizes. Do not snack on foods that contain a lot of calories, such as crisps, cakes, biscuits and sweets. If you're hungry between meals, eat fruit and vegetables and low-calorie foods. Increasing your level of exercise will also help to keep your weight stable.
• memory problems – if you're having problems with your memory, speak to your doctor. They may want to try a different medicine.

Pregabalin and pregnancy

Taking pregabalin during pregnancy may slightly increase the chance of birth defects in the baby.

You'll usually only be advised to take it if your doctor thinks the benefits of the medicine outweigh the risks.

If you take pregabalin and become pregnant, do not stop taking the medicine without talking to your doctor first. If you take pregabalin for epilepsy, it is particularly important that this is well treated during pregnancy, as seizures can harm you and your baby.

It's recommended to use effective contraception while taking pregabalin. If you plan to get pregnant, talk to your doctor first, as they may want to review your treatment.

If you're trying to get pregnant or have become pregnant while taking pregabalin, it is recommended to take high dose folic acid (5mg a day). You can get this from your doctor or midwife.

Ideally, you'll take high dose folic acid for 3 months before you start trying to get pregnant and for the first 12 weeks of pregnancy. Do not worry if you have not taken it before you get pregnant, but start taking it as soon as possible once you know that you are pregnant. It helps your baby to grow normally.

If you take pregabalin around the time of giving birth, your baby may need extra monitoring for a few days after they're born. This is because they may have pregabalin withdrawal symptoms.

Pregabalin and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take pregabalin while breastfeeding. It's important to keep taking pregabalin to keep you well.

Pregabalin passes into breast milk in small amounts, and it's unlikely to cause side effects in your baby.

If you're breastfeeding or planning to breastfeed, talk to your doctor or pharmacist, as other medicines we know more about might be better while you're breastfeeding, but they will help you decide.

If your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, talk to your doctor, pharmacist, health visitor or midwife.

For more information about how pregabalin can affect you and your baby during pregnancy, visit the Best Use of Medicines in Pregnancy (BUMPS) website.

Pregabalin can usually be taken safely with other medicines.

For safety, tell your doctor if you're taking any of these medicines before you start taking pregabalin:

• strong painkillers such as morphine
• medicines that make you feel sleepy or dizzy – pregabalin can make these side effects worse

Mixing pregabalin with herbal remedies and supplements

There are no known problems with taking herbal remedies and supplements with pregabalin.

However there's not enough information to say that complementary medicines and herbal remedies are always safe to take with pregabalin. They're not tested in the same way as pharmacy and prescription medicines.