Indeed, the absolute bioavailability of gabapentin drops from 60 to 33 % as the dosage increases from 900 to 3,600 mg/day, while the absolute bioavailability of pregabalin remains at ≥90 % irrespective of the dosage [15]. One could conclude from here that distinct pharmacokinetic advantages of pregabalin over gabapentin may translate into an improved therapeutic effect [5], but may explain as well why pregabalin is anecdotally perceived as more ‘powerful’ by drug misusers [10, 28]. The authors aim to present two case reports of pregabalin use disorder observed among migrants residing in a temporary detention center for undocumented migrants in Portugal, and to conduct a non-systematic review of the literature on the potential abuse of pregabalin. The prevalence of gabapentinoids in forensic settings has been evaluated in a number of studies (Table 2) with a focus on abuse and toxicity. Most of these studies were based on post-mortem data but some were generated by data from suspected DUID cases.
Additional Information for Patients and Caregivers
The trend is that there is an increasing number of fatalities over the last 15–20 years in which gabapentinoids have been involved, mainly pregabalin. In almost all cases, other drugs have been found, mainly opioids, benzodiazepines, alcohol, and antidepressant drugs. In relation to sales, Ojanperä et al. [56] found that the Finnish magic mushroom side effects number of deaths per million defined daily doses per year for pregabalin had an increasing trend from 2005 to 2013. Using this method for ranking the safety of 70 pharmaceuticals, pregabalin and gabapentin were ranked in the middle. An Irish study found an increase in the pregabalin poisoning deaths from 2013 to 2016 [51].
Signals in the Google Analytics Domain
They found that 8.5 % of these patients were dispensed a dose that exceeded the maximum daily allowance, with a previous drug misuse history having been identified in 31 % of this specific sub-sample. Similarly, Dyrkorn et al. [32] carried out in Norway a nationwide drug screening investigating 1,854 urine specimens, managing to identify pregabalin in 4.5 % of these samples. Finally, in a UK-based, anonymous, 1,500-respondent, online survey, Kapil et al. [26] compared misuse of baclofen, gabapentin and pregabalin. Respondents’ self-reported lifetime prevalence of gabapentin misuse (1.1 %) was similar to pregabalin (0.8 %) and baclofen (1.3 %), in contrast with an alleged lifetime prevalence of cocaine and cannabis use, respectively, of 8.1 and 28.1 %.
Data from Drug Utilization/Prescription Databases
Available evidence also suggests that abuse and misuse are more frequent in users of pregabalin compared with users of gabapentin. Health professionals and prescribers should be aware of the risk for misuse of pregabalin and gabapentin, which eventually could lead to abuse, substance dependence, and intoxications. Prescribing to patients belonging to risk populations such as those with psychiatric disorders or faqs what are fentanyl test strips substance use disorder should be avoided if possible and, if prescribed, signs of misuse and abuse should be monitored. Full texts were retrieved for articles deemed relevant based on the initial assessment. Articles were considered relevant if related to gabapentinoid abuse, misuse, dependence, addiction, and overdoses in humans. Inclusion in the study was based on author consensus after a full-text review.
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely. Drugs that treat seizures, such as Lyrica, may cause depression, anxiety, and suicidal thoughts or behaviors. This 10 panel drug test type of weight gain can happen quickly and contribute to or worsen heart failure. Tell your doctor about all medications you’re taking before starting Lyrica. If you’re concerned about the side effects of combining Cymbalta and Lyrica, talk with your doctor or pharmacist.
It is important to note, however, that this reviewmay overrepresent individuals who have abused substances, illustrating theimportance of examining gabapentin misuse in the general population. Further, greyliterature was excluded, which may have provided more information from which toinfer risk factors for misuse, along with other characteristics of gabapentinmisuse/abuse. Still, the present review emphasizes the paucity of peer-reviewedresearch on this important emerging topic, and provides key starting points forsubsequent examination. Studies indicate gabapentin is misused/abused over a wide range ofdoses, from within therapeutic range (900–3600 mg/day) tosupratherapeutic doses. All but two articles discussed the dosage involvedin gabapentin misuse (42, 47). Evidence from the US suggestedthat gabapentin misuse among individuals with prescriptions for gabapentininvolved a higher amount than prescribed (45, 46, 61).
Somewhat different results were seen in a study by Zacny et al. [70] showing that abuse liability-related subjective effects such as drug liking and desire to take the drug again were not increased by pregabalin dose. It is difficult to ascertain risk factors for gabapentin misuse/abuse excepthistory of or current drug abuse, particularly opioids, is likely one from reportsavailable to date. While no studies to date have formally assessed a history of orcurrent substance abuse (especially drug abuse) as a risk factor for gabapentinmisuse, it was the most common characteristic detected here.
A new interesting possibility is to analyze wastewater to study substance consumption, which provides a picture of changes, over time and between different areas, in the total consumption, including non-prescribed use [115]. Prescribers in the USA, in contrast to European prescribers, might consider gabapentinoids a safer non-opioid pain medication in the context of the opioid overdose epidemic in the USA [92, 96]. However, other differences in regulations, healthcare systems, ease of access, and perceptions by users might also add to these differences. That is despite advice from Public Health England and the National Health Service England in 2014 [64]. The initial search yielded 1,128 unique citations, of which 1,067 wereexcluded based on title or abstract (Figure 1).Sixty-one articles were read in their entirety to assess whether they met inclusioncriteria. Twenty-eight were excluded because they did not actually describegabapentin misuse, abuse, or diversion.
Five participants from the total sample reported recent (past 90 days) misuse of pregabalin and were asked additional follow-up questions about their experiences. The median values of search analytics over time were 82.5, IQR [53.25, 128] for pregabalin, 37, IQR [16.25, 47] for gabapentin, and 203.5, IQR [145.25, 258] for clonazepam. Search interest over time for abuse-related terms in the search analytics domain. For the period 2007Q1 to 2020Q2, the search interest over time for abuse-related terms is represented in timelines for each drug and is expressed as quarterly relative search volume for overall abused-linked terms.
If you develop serious side effects while taking Lyrica, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number. Lyrica is typically used long-term to treat these conditions if you and your doctor agree the drug is safe and working well for you. Lyrica is also used along with other drugs to treat a specific kind of seizure in certain children. If you have a certain kind of nerve pain or seizures, your doctor might suggest Lyrica as a treatment option for you.
- Our group has recently published the methodology of combining these pharmacovigilance domains in order to detect safety signals (12, 13).
- This means it has the potential for misuse or dependence and that the U.S. government has special regulations in place regarding the use of this drug.
- Further studies to identify risk factors for gabapentinmisuse and to characterize gabapentin’s abuse liability are recommended.
- Similarly, remaining prescription drugs with misuse potential (e.g. benzodiazepines; z-hypnotics) were considered ‘safe’ for many years before their addictive liability levels were identified [49].
Pregabalin is a widely prescribed medication for various medical conditions, including neuropathic pain and anxiety disorders. Recently, several studies have shown an increase in the recreational use of pregabalin, particularly among vulnerable populations, such as the migrant population. Concluding, the present study revealed a safety signal for the abuse potential of pregabalin and gabapentin using two different methods of surveillance, the FAERS database analysis and big data search analytics. We suggest that these methods can be used in combination as a supplementary pharmacovigilance tool to detect drug safety signals.
Frequency of misuse of these molecules was monthly in 37 % of cases and between once per month and once per week in 50 %. There are several pharmacovigilance studies describing the abuse and misuse of gabapentinoids (Table 1). Two recent US studies reported data from the US Food and Drug Administration adverse event reporting system [16, 17], included pregabalin and gabapentin reports during the period 2012–16 [17] and 2005–12 [16]. Both studies, partly covering the same data, found a higher proportion of abuse-related reports for pregabalin (10.2% of 571 reports [17] and 26.1% of 97,813 reports [16]) compared with gabapentin (5.7% of 10,038 reports [17] and 22.9% of 99,977 reports [16]). A second study [43] (not included in Table 1) also using Eudravigilance data reported 13 cases of nasal pregabalin use in individuals with current or past substance dependency or misuse.
To detect pregabalin’s and gabapentin’s abuse potential in comparison with two controls, clonazepam and levetiracetam and (ii). To investigate the correlation between the search analytics and the FAERS domain. Our group has recently published the methodology of combining these pharmacovigilance domains in order to detect safety signals (12, 13).
Moreover, earlier abuse of cocaine has also been mentioned as a risk factor for gabapentinoid abuse [48, 69]. There are studies reporting that 15–22% and 3–68% of patients with opioid use disorders abuse gabapentin and pregabalin, respectively [39–42, 48, 49, 64]. Other studies confirm high rates of gabapentinoid abuse in opioid addicts [20, 21, 42, 64, 66–68]. This review summarizes current evidence on the abuse and misuse of the gabapentinoids pregabalin and gabapentin. Studies found that gabapentinoids are abused and misused and that individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk. Moreover, some evidence supports the notion that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids.