Growing evidence suggests an increase in the misuse of pregabalin in Australia. Coronial data identifies 88 pregabalin-associated deaths in New South Wales between 2005 and 2016, while Victoria saw a 12-fold increase in pregabalin-related ambulance call-outs between 2012 and 2017.

Pregabalin, an analogue of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), was initially developed for the treatment of partial seizures. However, use rose significantly following widening of its indications to include the treatment of neuropathic pain. Statistics from the Pharmaceutical Benefits Scheme (PBS) place pregabalin at number eight on the 2015 list of drugs by total cost to Australia, while it was unranked in 2014.

Originally thought to be non-addictive, post-marketing data demonstrates a potential for misuse and abuse. Similarly to tranquilisers, pregabalin can produce sedation and euphoria. This can be particularly dangerous if combined with other centrally acting drugs, such as opioids and benzodiazepines. Animal studies also suggest that pregabalin may reduce tolerance to some opioids, such as oxycodone and morphine, which would further increase the risk of respiratory depression. Withdrawal symptoms such as insomnia, headache, nausea, and hyperhidrosis have also been reported following discontinuation of pregabalin therapy.

Strategies that may be considered to reduce the risks associated with this medication include:

  • Careful evaluation of patients for a history of substance abuse;
  • Observe patients for signs of abuse or misuse;
  • Avoid off-label prescribing;
  • Limit the quantity provided to patients at one time;
  • Consider a tapering regimen when discontinuing use;
  • Regularly assess risk versus benefit of therapy; and
  • Avoid combination with opioids or benzodiazepines.

References:

  1. Australian Government Department of Health. Australian Statistics on Medicines 2015. Canberra: The Pharmaceutical Benefits Scheme; 2016.
  2. Lyrica® (pregabalin) Australian approved product information. West Ryde: Pfizer Australia. Approved September 2016.
  3. Notice from Queensland Health Medicines Regulations and Quality Unit regarding Lyrica®. Brisbane: RACGP Queensland Newsletter; 2018.

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