Pregabalin vs Gabapentin - Comparison Guide & Similarities

By: Dr. Nima Mehran | MD

Pregabalin vs Gabapentin - Key Similarities

• Both pregabalin and gabapentin FDA approved to treat postherpetic neuralgia and adjunctive therapy for partial seizures. Both are also used to treat neuropathic pain, fibromyalgia, refractory chronic cough, anxiety/panic disorders and other medical conditions.

• They are both classified as anticonvulsants or antiepileptic drugs.

• Both medications work by affecting calcium channels in nerve cells to reduce abnormal electrical activity.

• Common side effects for both drugs include dizziness, drowsiness, and swelling in the hands or feet.

• Pregabalin and gabapentin are both eliminated from the body through the kidneys, so dose adjustments may be necessary in patients with kidney impairment.

Gabapentin vs Pregabalin Key Takeaways

• Pregabalin and gabapentin are both used to treat nerve pain and certain types of seizures, but pregabalin is approved for additional conditions such as fibromyalgia and nerve pain from diabetes and spinal cord injuries.

• Pregabalin is absorbed more quickly and completely than gabapentin, leading to a faster onset of action and more predictable effects as the dose increases. Clinical studies suggest pregabalin may provide greater and faster pain relief compared to gabapentin, and patients may experience better improvements in quality of life.

• Both drugs can cause side effects like dizziness and drowsiness, but gabapentin is more likely to cause nausea and vomiting, while pregabalin is more associated with weight gain.

• Pregabalin is classified as a controlled substance in all states due to a higher risk of misuse, whereas gabapentin is only controlled in some states. Both should be used with caution in people with a history of substance use.

Pregabalin vs Gabapentin: Drug Comparison Table

Pregabalin vs Gabapentin - Dosage Guidelines

Special notes Faster, more predictable Absorption less predictable

Gabapentin vs Pregabalin - Side Effects Comparison

When considering pregabalin and gabapentin for conditions like nerve pain or seizures, understanding their side effects is important for making an informed choice. Both medications are known to cause similar types of side effects, but there are some differences in how often these occur and how severe they might be.

The most common side effects for both pregabalin and gabapentin include dizziness and drowsiness. These can affect your ability to concentrate or perform tasks that require alertness, such as driving or operating machinery. Some people also experience swelling in the arms and legs, known as edema, as well as dry mouth and vision changes. While these side effects are generally mild and may improve as your body adjusts to the medication, they can be bothersome for some people.

There are a few differences in the side effect profiles of these two drugs:

• Weight gain: Both medications can cause weight gain, but pregabalin is more likely to lead to weight gain (0-14%) that is not just due to fluid retention. With gabapentin (2-3%), weight gain is usually related to extra fluid in the body.

• Nausea and vomiting: Studies have shown that gabapentin (<8%) is more likely than pregabalin (1-5%) to cause nausea and vomiting. This means that if you have a sensitive stomach or have had trouble with nausea from medications in the past, pregabalin might be a better option.

• Serious allergic reactions: Both drugs can rarely cause severe allergic reactions, such as swelling of the face, mouth, or throat (angioedema). Both medications have also been linked to a rare but serious reaction called DRESS syndrome, which includes symptoms like rash and fever. If you notice any signs of an allergic reaction, seek medical help right away.

In addition to these, both pregabalin and gabapentin carry some risks that, while uncommon, are important to be aware of:

• Mood and behavior changes: Both medications can increase the risk of suicidal thoughts or actions at any point during treatment. Pregabalin may have a slightly higher risk in this area. If you or someone you know experiences new or worsening mood changes, depression, or thoughts of self-harm, contact a healthcare provider immediately.

• Heart and breathing problems: There is a small increased risk of heart problems with both drugs, and gabapentin may be linked to more heart-related risks in the short term. Both medications can also cause breathing problems, especially if taken with other drugs that slow down brain activity, such as opioids, certain anxiety medications, or even alcohol. Combining these substances can lead to excessive drowsiness and slowed breathing, which can be dangerous.

• Withdrawal symptoms: Stopping either medication suddenly can cause withdrawal symptoms like nausea, agitation, sweating, or, in people taking them for seizures, a return of seizures. It’s important to follow your doctor’s instructions when stopping or switching these medications.

Overall, while pregabalin and gabapentin share many side effects, pregabalin is more likely to cause weight gain, and gabapentin is more likely to cause nausea and vomiting. Both medications can cause serious side effects in rare cases, so it’s important to monitor for any unusual symptoms and communicate with your healthcare provider about any concerns. Your doctor will consider your medical history, other medications you take, and your personal preferences when recommending the best option for you.

Pregabalin vs Gabapentin: Interactions Comparison

Pregabalin and gabapentin are both commonly used to treat nerve pain and certain types of seizures, but there are important differences in the specific conditions each is approved to treat and how they are used in practice. Understanding these differences can help patients and caregivers make informed decisions about which medication might be most appropriate for their needs.

Both pregabalin and gabapentin are approved for use as add-on therapy for partial onset seizures. Pregabalin can be prescribed for adults and children as young as one month old, while gabapentin is approved for adults and children at least three years old. In addition to their use in seizure management, both medications are approved to treat nerve pain that can occur after shingles, a condition known as postherpetic neuralgia.

Pregabalin has a broader range of approved uses compared to gabapentin. In addition to seizures and postherpetic neuralgia, pregabalin is specifically approved for:

• Nerve pain caused by diabetes (diabetic neuropathy)

• Nerve pain resulting from spinal cord injuries

• Fibromyalgia, a condition characterized by widespread pain and tenderness

Gabapentin, on the other hand, does not have official approval for diabetic neuropathy, spinal cord injury-related nerve pain, or fibromyalgia. However, it is often prescribed “off-label” for these and other conditions. Off-label use means that a medication is being used to treat a condition even though it is not specifically approved for that purpose by regulatory agencies. In practice, gabapentin is frequently chosen as a first-line treatment for diabetic neuropathy and is also used for fibromyalgia, despite the lack of formal approval.

Both medications are also used off-label for a variety of other conditions, including:

• Other types of nerve pain

• Menopause-related symptoms such as hot flashes and night sweats (gabapentin is preferred for these symptoms)

• Muscle and bone pain, such as back pain

• Panic and anxiety disorders

• Pruritis, uremic and or (neuropathic or malignancy related)

• Cough, chronic refractory

• Headaches/migraines

• Restless leg syndrome (gabapentin has an extended-release form approved for this)

• Alcohol use disorder and alcohol withdrawal

• Essential tremors

• Hiccups (uncontrollable)

It is important to note that while both drugs are used for a wide range of conditions, the choice between them often depends on the specific health issue being treated, the patient’s medical history, and how well the medication is tolerated. For example, when it comes to managing nerve pain, some studies suggest that pregabalin may work faster and provide better pain relief than gabapentin, and it is more likely to be recommended for certain types of nerve pain. However, for menopause-related symptoms like hot flashes, gabapentin is generally preferred due to more supporting research.

In summary, pregabalin and gabapentin share several approved uses, especially for seizures and nerve pain after shingles, but pregabalin has more official approvals for additional types of nerve pain and fibromyalgia. Both medications are widely used off label for other conditions, and the decision about which to use should be made in consultation with a healthcare provider, taking into account the specific condition, available evidence, and individual patient needs.

When to Choose Each Medication

Gabapentin

• Lower cost important

• Milder nerve pain

• Menopause symptoms treatment

• Less risk of weight gain

• Not a controlled substance (most states)

Pregabalin

• Faster pain relief needed

• More severe neuropathic pain

• Lower opioid use preferred

• Better absorption

• FDA-approved for fibromyalgia

Pregabalin vs Gabapentin - Safety Considerations

When considering the safety of pregabalin and gabapentin, it’s important to understand both the common and more serious side effects, as well as the risks associated with stopping these medications or combining them with other drugs. Both pregabalin and gabapentin are generally well tolerated, but there are some differences in their safety profiles that may influence which medication is best for a particular person.

The most common side effects for both pregabalin and gabapentin include dizziness and drowsiness. These effects can make you feel tired or unsteady and may be less noticeable with extended-release versions of the medications. Other possible side effects that can occur with either drug are:

• Swelling in the arms and legs (also called edema)

• Blurred vision or other eye problems

• Dry mouth

• Weight gain (more likely with pregabalin, and not always related to fluid buildup)

• Headache

• Nausea and vomiting (more common with gabapentin)

While most side effects are mild and go away as your body adjusts, some people may experience more serious reactions. Both pregabalin and gabapentin can increase the risk of suicidal thoughts or actions at any point during treatment. Pregabalin may be more likely to cause these changes in mood or behavior than gabapentin. If you or someone you know notices new or worsening depression, mood changes, or thoughts of self-harm, it’s important to seek help right away.

Other serious risks include:

• Heart problems: Both medications have been linked to an increased risk of heart issues, with pregabalin having a higher risk of cardiovascular risk since it has greater potency, faster onset and higher bioavailability.

• Breathing problems: Taking pregabalin or gabapentin with other medications that slow down brain activity—such as opioids, benzodiazepines, or certain allergy medicines—can lead to excessive sleepiness and slowed or difficult breathing. Alcohol can also increase this risk.

• Withdrawal symptoms: Stopping either medication suddenly can cause withdrawal symptoms like nausea, agitation, sweating, and, for those taking them for seizures, a return of seizures. It’s important to follow your doctor’s instructions when stopping or switching these medications.

• Allergic reactions: Rarely, both pregabalin and gabapentin can cause a severe allergic reaction called DRESS syndrome, which includes fever and rash. Both drugs can also cause swelling of the face, mouth, or throat (angioedema). If you notice these symptoms, seek medical attention immediately.

Pregabalin is classified as a controlled substance in all states, meaning it has a higher risk for dependence and misuse compared to many other medications. Gabapentin is only considered a controlled substance in some states, but both drugs can lead to dependence if not used as prescribed. This means there are restrictions on how often you can refill your prescription and how much you can get at one time.

To reduce the risk of side effects and complications, it’s important to:

• Take the medication exactly as prescribed

• Avoid combining pregabalin or gabapentin with alcohol or other sedating medications unless your doctor says it’s safe

• Let your healthcare provider know about all other medications and supplements you are taking

• Report any new or unusual symptoms, especially changes in mood, swelling, or difficulty breathing

In summary, while both pregabalin and gabapentin are effective for nerve pain and seizures, they come with potential risks that should be discussed with your healthcare provider. Your doctor will consider your medical history, other medications, and personal preferences to help choose the safest and most effective option for you.

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