The December edition of Medicines Safety Update reminds of the risk of suicidal behaviour or ideation associated with the use of pregabalin (Lyrica®), an analogue of gamma-aminobutyric acid.

Studies reported in the product information showed that drug treatments generally double the already heightened risk of suicidality in epileptics, to one case for every 530 patients treated. From April 2005 to 20th August 2014, pregabalin was implicated in two reports of suicide, two of attempted suicide, seven of suicidal behaviour, and 57 cases of suicidal thoughts. These reports should be balanced against Medicare statistics which show demand reaching 1.6 million prescriptions within the 12 months prior to June 2014, following Pharmaceutical Benefits Scheme listing for neuropathic pain. Prescriptions for adjunctive therapy in adults with partial seizures or for off-label purposes are not included in this data.

Patients who are prescribed pregabalin for any purpose should be monitored for depression, suicidal thoughts or behaviours, and changes in mood or behaviour. Furthermore, patients and caregivers should be advised of these risks and educated to recognise and report the associated symptoms.

The risks of treatment with pregabalin should be weighed against the risks of the untreated illness.

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