Currently, reports from the UK are causing a stir. The reason is data from the British statistical authority, according to which there have been increasing deaths in connection with the intake of Pregabalin from 2018 to 2022.Pregabalin (also known under the brand name Lyrica®) is one of the most frequently prescribed drugs in Germany. It is approved for the treatment of neuropathic pain, as an adjunctive therapy for partial epileptic seizures, and for generalized anxiety disorder.
Pregabalin in symptomatic therapy
Due to its very good effect on neuropathic pain, Pregabalin is often used as symptomatic therapy in MS. Especially when sufferers are plagued by distressing sensations and pain that restrict everyday life and affect quality of life. Here, the prescription of Pregabalin can be extremely helpful. Moreover, the drug is also popular because it has hardly any interactions with other substances. The substance is absorbed quickly and linearly, hardly metabolized and almost completely excreted unchanged in the urine.
Is Pregabalin addictive?
However, despite generally good tolerance, a possible risk of dependency on Pregabalin has been discussed for several years. The literature contains epidemiological studies and case series on the potential for Pregabalin dependency, with dosages reported that were significantly above the recommended therapeutic doses. The combination of Pregabalin with drugs or other medications is particularly problematic. The risk of serious side effects and interactions increases significantly with simultaneous intake of opiates in particular, but also benzodiazepines and alcohol. Thus, studies that have investigated deaths associated with so-called gabapentinoids (which include Pregabalin) have shown that in over 90% of cases, simultaneous use of opiates was detectable. Only in a low single-digit number of patients could the cause of death be attributed to sole intoxication with gabapentinoids. Furthermore, only a small proportion of the cases studied had been prescribed Pregabalin by a doctor.
In this context, the figures from the British statistical authority need to be viewed more differentiatedly, in that the mere association of deaths with the intake of Pregabalin is not the same as a causal connection. On the one hand, there has been a continuous increase in prescriptions of Pregabalin in recent years, which contributes to the rising numbers. On the other hand, gabapentinoids are often detected as “co-consumption” in fatal overdoses of drugs. Whether gabapentinoids play a causal role in terms of lethality is not yet clear.
Pregabalin and opioid abuse
Based on the available data, it can be assumed that the risk of Pregabalin dependency is particularly high in individuals who misuse opioids. In this group, the prevalence of Pregabalin dependency is estimated to be up to 68%. Therefore, it is certainly not sensible to call for a ban on Pregabalin in the light of the current figures. Because that would mean denying many patients access to an effective and helpful medication when it is prescribed appropriately and used correctly.
However, the current figures should contribute to reflecting critically on prescriptions of Pregabalin and looking out for signs of misuse (such as independent dose increases). Special caution is required especially in patients with a history of drug abuse.
Do not stop taking Pregabalin without consulting a doctor
I would like to appeal at the end that MS patients who are now insecure because of the current media reports should not stop taking Pregabalin without consulting a doctor. Because with its proper use, it remains a highly effective medication – and dependency is rare in non-addicted individuals.
