pregabalin

Adjunctive therapy

Brands: LYRICA, LYRICA CR

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

View details

Quick answers

What is pregabalin?
Pregabalin (brand Lyrica) is an α2δ calcium-channel ligand approved for neuropathic pain syndromes, fibromyalgia, and adjunctive therapy for partial-onset seizures (label). In many countries it is also approved for generalized anxiety disorder; in U.S. psychiatric practice it is used off label for anxiety symptoms and sleep complaints when clinicians want an alternative to benzodiazepines.
What is LYRICA?
LYRICA is a brand name for pregabalin (other brands: LYRICA CR).
What is LYRICA (pregabalin) used for?
Label indications include: Neuropathic pain (diabetic peripheral neuropathy, postherpetic neuralgia, spinal cord injury); fibromyalgia; adjunctive therapy for partial-onset seizures (label). Off-label psychiatry use includes anxiety symptoms and insomnia adjuncts.
What drug class is LYRICA (pregabalin)?
Alpha-2-delta (α2δ) ligand that modulates voltage-gated calcium channels and reduces excitatory neurotransmitter release.
What strengths does LYRICA (pregabalin) come in?
Capsules: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg.

Snapshot

Primary label indications include: Neuropathic pain (diabetic peripheral neuropathy, postherpetic neuralgia, spinal cord injury); fibromyalgia; adjunctive therapy for partial-onset seizures (label).
Class: Adjunctive therapy
Common US brands: LYRICA, LYRICA CR
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Label indications

Neuropathic pain (diabetic peripheral neuropathy, postherpetic neuralgia, spinal cord injury); fibromyalgia; adjunctive therapy for partial-onset seizures (label). Off-label psychiatry use includes anxiety symptoms and insomnia adjuncts.

View labelExact

Clinical Highlights

Pregabalin (brand Lyrica) is an α2δ calcium-channel ligand approved for neuropathic pain syndromes, fibromyalgia, and adjunctive therapy for partial-onset seizures (label). In many countries it is also approved for generalized anxiety disorder; in U.S. psychiatric practice it is used off label for anxiety symptoms and sleep complaints when clinicians want an alternative to benzodiazepines. Compared with gabapentin, pregabalin has more consistent absorption and is often dosed BID. Clinically, patients may describe faster onset of “calming” and sleep continuity, but the trade-off is higher rates of dizziness, weight gain, and peripheral edema in many cohorts.

The primary role is as an adjunct, not a first-line long-term strategy. If anxiety is persistent and impairing, prioritize psychotherapy and SSRI/SNRI strategies; consider pregabalin as a bridge when sedation is acceptable and misuse risk is low.
Pregabalin is renally cleared with negligible metabolism, so renal function (eGFR/CrCl) is the key determinant of safe dosing. Declining renal function can present as oversedation, confusion, and falls.
Pregabalin is Schedule V in the U.S. Misuse/diversion and co-use with opioids or other sedatives increase risk; treat early refills and dose escalation as safety signals and avoid open-ended “PRN forever” prescribing.
The pregabalin compare view, pregabalin evidence feed, and pregabalin print page can help align expectations around sedation, weight gain/edema, and misuse risk.

Dosing & Formulations

Capsules: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg (label). Off-label anxiety/sleep use typically starts low and is titrated slowly over days to weeks based on sedation and dizziness; avoid rapid escalation that can look like intoxication or trigger falls.

Because pregabalin is renally cleared, dosing should be adjusted in renal impairment; reassess after acute illness or dehydration that can reduce clearance.
Avoid abrupt discontinuation after sustained use—taper to reduce rebound anxiety/insomnia and withdrawal-like symptoms.

Monitoring & Risks

Sedation/dizziness: monitor next-day impairment, driving safety, and falls, especially during initiation and titration. Weight gain and peripheral edema are clinically meaningful risks; track weight and swelling and reassess if patients report dyspnea or rapid weight change.

Respiratory depression risk increases with opioids, benzodiazepines, and alcohol or in patients with underlying lung disease; avoid stacking sedatives.
Misuse/diversion and intoxication can occur; schedule controlled substance follow-up and treat early refills or dose escalation as red flags.

Drug Interactions

Minimal CYP interactions (negligible metabolism), so medication reconciliation focuses on additive CNS depression and renal clearance. Additive sedation with benzodiazepines, opioids, alcohol, and other sedatives; coordinate dose reductions and safety planning when combinations cannot be avoided.

Practice Notes

Define the target symptom (sleep maintenance, somatic tension, ruminative worry) and reassess within weeks; avoid indefinite continuation without clear benefit. In serious mental illness, sedation can worsen negative symptoms and functional impairment; weigh daytime functioning against symptom relief.

Use additional safeguards for controlled-substance prescribing: limited quantities, no automatic refills, and documentation of substance use risk and co-prescribed sedatives.

References

Pregabalin prescribing information (Lyrica) — DailyMed (2025)
Gabapentin and Pregabalin for the Treatment of Anxiety Disorders — Clinical Pharmacology in Drug Development (2018)
A Meta Analysis OF THE Efficacy OF Pregabalin IN THE Treatment OF Generalized Anxiety Disorder — The Canadian Journal of Psychiatry (2011)
Pregabalin for generalized anxiety disorder — International Clinical Psychopharmacology (2017)
Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update — Drugs (2021)