Lyrica vs. Gabapentin for Pain: Differences between Uses & Side Effects

Lyrica (pregablin) vs. gabapentin (Neurontin) quick comparison

• Lyrica (pregablin) and gabapentin (Neurontin) are anti-epileptic medications used to treat seizures and nerve pain (neuropathic pain).
• Gabapentin also is used to treat nerve pain caused by shingles (herpes zoster).
• Other uses for Lyrica are neuropathic (nerve) pain associated with diabetic peripheral neuropathy or postherpetic neuralgia, and fibromyalgia.
• Side effects of gabapentin and that are similar include:
  • Dizziness
  • Drowsiness
  • Loss of balance or coordination
  • Problems with memory or concentration
  • Tremors
  • Vision problems (blurred vision or double vision)
• Side effects of gabapentin that are different from Lyrica include:
  • Difficulty speaking
  • Viral infections
  • Fever
  • Unusual eye movements
  • Jerky movements
• Side effects of Lyrica that are different from gabapentin include:
  • Dry mouth
  • Constipation
  • Swelling (edema)
  • Breast enlargement
  • Weight gain
• Both gabapentin and Lyrica may interact with alcohol and drugs that cause sedation including narcotic pain medications.  Gabapentin also may interact with nonsteroidal anti-inflammatory drugs (NSAIDs).
• Neurontin, Gralise, Horizant, Fanatrex, and FusePag) are the brand names available for gabapentin in the US. Pregabalin is the generic name for the brand name Lyrica.

What is Lyrica? What is gabapentin? How do they work?

Gabapentin is an anti-seizure (anti-convulsant) drug that is used for preventing seizures and for treating post-herpetic neuralgia, the pain that follows an episode of shingles. Doctors do not know how gabapentin works. Gabapentin structurally resembles the neurotransmitter gamma aminobutyric acid (GABA). It is possible that this similarity is related to gabapentin's mechanism of action. In animal models used for testing the anticonvulsant and analgesic (anti-pain) activities of drugs, gabapentin prevents seizures and reduces pain-related responses.

Lyrica (pregabalin) is an oral medication that is chemically related to gabapentin (Gralise, Neurontin). It is used for treating pain caused by neurologic diseases such as postherpetic neuralgia as well as seizures. It also is used for treating fibromyalgia.

What are the uses for Lyrica vs. gabapentin?

Lyrica uses

Lyrica is used for:

• Neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia
• Spinal cord injury
• In combination with other drugs to treat partial onset seizures in adults
• Treating fibromyalgia

Gabapentin uses

Gabapentin is approved for treating seizure disorders and nerve damage from herpes zoster (shingles, postherpetic neuralgia).

There are many non FDA-approved uses for gabapentin. These include:

• Alcohol withdrawal
• Cocaine withdrawal
• Hiccups
• Restless leg syndrome
• Hyperhidrosis
• Headaches
• Diabetic neuropathy
• Hot flashes
• Fibromyalgia

What are the side effects of Lyrica vs. gabapentin?

Lyrica side effects

SIDE EFFECTS WARNING: Antiepileptic medications have been associated with increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

The most common side effects of Lyrica include:

• dizziness,
• drowsiness,
• dry mouth (xerostomia),
• edema (accumulation of fluid),
• blurred vision,
• double vision (diplopia),
• weight gain,
• fatigue (tiredness),
• abnormal gait (ataxia),
• tremor, and
• difficulty concentrating.

Other side effects include

• constipation,
• increased appetite,
• nausea,
• flatulence,
• amnesia,
• disorientation,
• myoclonus (sudden, involuntary jerking of a muscle or muscle groups),
• heart failure,
• low blood pressure,
• vomiting,
• reduced blood platelet counts, and
• increased blood creatinine kinase levels.

Increased creatinine kinase can be a sign of muscle injury, and in clinical trials three patients experienced rhabdomyolysis (severe muscle injury). Therefore, patients should report unexplained muscle pain, tenderness or weakness to their doctors, especially if associated with fever and malaise (reduced well-being). Lyrica has rarely been associated with angioedema (swelling of the face, tongue, lips, and gums, throat and larynx).

Gabapentin side effects

The most common side effects of gabapentin are:

• Dizziness
• Sleepiness
• Ataxia
• Fatigue
• Drowsiness
• Fluid retention (edema)
• Hostility
• Nausea
• Vomiting
• Difficulty speaking
• Jerky movements
• Unusual eye movements
• Double vision
• Tremors
• Memory loss
• Unsteadiness

Other adverse effects and serious side effects associated with gabapentin include:

• Weight gain
• Joint pain
• Motion sickness
• Blurred vision
• Viral infection

Antiepileptic medications have been associated with an increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

Is gabapentin addictive? Is it a narcotic?

Gabapentin is not an opioid narcotic, and it is not classified as a controlled substance by the Drug Enforcement Agency (DEA). However, this medication does share signs and symptoms associated with drug misuse, addiction, and withdrawal symptoms of opioids like:

• Sweating
• Anxiety
• Muscle pain
• Insomnia
• Goosebumps (philoerections)
• There have been reports of patients abusing this drug.

What is diabetic peripheral neuropathy?
See Answer

What is the dosage of Lyrica vs. gabapentin?

Lyrica dosage instructions

• Lyrica may be taken with or without food.
• Treating diabetic peripheral neuropathy: The initial dose for neuropathic pain associated with diabetic peripheral neuropathy is 50 mg three times a day (150 mg/day). The dose may be increased to a maximum dose of 100 mg 3 times daily (300 mg/day) after one week.
• Treating postherpetic neuralgia: The recommended dose for postherpetic neuralgia is 75-150 mg twice daily or 50-100 mg three times daily. Dosing should begin at 75 mg two times a day or 50 mg three times a day (150 mg/day). The dose may be increased to 100 mg 3 times daily (300 mg/day) after one week. If pain relief is inadequate after 2-4 weeks of treatment at 300 mg/day, the dose may be increased to 300 mg twice daily or 200 mg three times daily. Doses greater than 300 mg cause more side effects.
• Treating neuropathic pain associated with spinal cord injury: The dose for treating neuropathic pain associated with spinal cord injury is 150 to 600 mg daily. Begin dosing at 75 mg two times a day an increase to 150 mg two times daily after one week if response is inadequate. May increase to 300 mg twice daily if response is inadequate after 2 to 3 weeks.
• Treating seizures: The recommended dose for treating seizures is 150-600 mg/day divided into 2 or 3 doses, starting at 150 mg daily and increasing based on response and tolerability. The maximum dose is 600 mg/day.
• Treating fibromyalgia: Fibromyalgia is treated with 300-450 mg/day in 2 or 3 divided doses.

Gabapentin dosage instructions

• Gabapentin may be taken with or without food.
• Treating postherpetic neuralgia: The recommended dose for postherpetic neuralgia is 1800 mg daily in 3 divided doses (Neurontin) or 1800 mg once daily (Gralise). Gralise is not interchangeable with other gabapentin products.
• Treating seizures: Seizures are treated with 900-1800 mg/daily in 3 divided doses (Neurontin). Withdrawal of treatment should occur slowly over a week.

What drugs interact with Lyrica vs. gabapentin?

Lyrica drug interactions

• Alcohol and drugs that cause sedation may increase the sedative effects of pregabalin.
• Pioglitazone (Actos) and rosiglitazone (Avandia) cause weight gain, fluid retention, and possibly heart failure. Therefore, combining pregabalin with these drugs may increase the occurrence of weight gain and fluid retention.

Gabapentin drug interactions

• Antacids reduce the concentration of gabapentin in blood. Therefore, gabapentin should be administered 2 hours or more after taking antacids.
• Morphine significantly increases blood concentrations of gabapentin and may increase central nervous system-related adverse events associated with gabapentin.

Are Lyrica or gabapentin safe to take if I am pregnant or breastfeeding?

Lyrica safety

• There are no adequate studies of Lyrica in pregnant women.
• It is not known whether Lyrica is excreted in breast milk.

Gabapentin safety

• Doctors do not know the safety of gabapentin during pregnancy.
• Gabapentin is secreted in human breast milk; therefore, if you are pregnant you should only use this medication if the benefits outweigh the unknown risk to the fetus.