Tox Tuesday: Gabapentin/Pregabalin

For this special edition of Tox Tuesday, we’re looking at two drugs: their similarities, differences, abuse and more. We’re going to go in depth with gabapentin and pregabalin, both of which are anticonvulsant drugs.

First up, gabapentin: originally developed to treat epilepsy, but is now also being used to relieve neuropathic pain. In other cases, gabapentin has been prescribed for restless leg syndrome, anxiety disorders, bipolar disorder and more. Gabapentin is not a scheduled drug in the United States.

Pregabalin, on the other hand, has been found to be effective for generalized anxiety disorder, and is used for this purpose in the European Union and Russia. It was approved in the United States in 2004, classified as a Schedule V drug. On a smaller scale, the drug can also be used in some cases for chronic fibromyalgia pain.

Unfortunately, like many other drugs, gabapentin and pregabalin have increasingly been abused. According to NHS Lothian, based in Scotland, the first documented case of abuse of the drugs was reported in 1997.

The original patient from that case—a previous cocaine addict who became addicted to gabapentin pills—seems to have been a precursor for further abuse down the line. A 2012 study showed that those with past drug-seeking behaviors may be more inclined to abuse pregabalin, although some data suggests that the drug has a “very low potential for abuse.”

Other statistics may suggest otherwise. One report cites that pregabalin prescriptions increased by 350% and gabapentin prescriptions increased by 150% in just five years. The report goes on to say that “these drugs are now commonly being detected in toxicology autopsies after drug overdoses.”

So are people abusing the drug or not? Yes! In the United Kingdom, concerns have been raised over the abuse of both gabapentin and pregabalin. When blood samples of recent drug overdoses were sampled, these drugs (along with buprenorphine) were found in the samples. Patient visits to hospitals are also increasing in Northern Ireland due to abuse of the drugs.

Pregabalin seems to be the more popular choice out of the two. The drug is ingested primarily orally, but is also abused through intravenous, rectal and “parachuting” methods. One of the reasons this may be is that abusers need to take far less of pregabalin than gabapentin to achieve the same recreational high. Among both drugs, tolerance develops quickly.

Some side effects of pregabalin abuse include dizziness, vertigo, balance issues, blurred vision, confusion, euphoria and fatigue, among others.

Gabapentin side effects include feelings of drowsiness, unsteadiness, dry mouth and lack of coordination.

However, the drugs aren’t all bad news. Gabapentin has been part of clinical trials to deal with severe morning sickness during pregnancy, and may also be a treatment for alcoholism. When used appropriately, pregabalin can be quite effective with pain treatments or for seizure patients when conventional treatments fail.

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