Pregabalin for multiple sclerosis
Fact-checked by What is pregabalin for MS?
Pregabalin is an oral medication sometimes used off-label in people with multiple sclerosis (MS) to manage neuropathic pain, or pain related to nerve damage, and spasticity, or involuntary muscle contractions and spasms.
The therapy is formally approved in the U.S. for partial onset seizures, fibromyalgia (a condition marked by widespread pain), and neuropathic pain associated with diabetes, spinal cord injury, or shingles infection.
Nervous system damage in MS can cause spasticity and abnormal sensations such as burning, stabbing, numbness, and tingling that characterize neuropathic pain. These MS symptoms are driven in part by the excessive release of certain signaling chemicals, or neurotransmitters, that causes overactivation of nerve cells involved in pain and movement.
Pregabalin is thought to calm this overactivity by binding to certain calcium channel proteins at the surface of nerve cells and suppressing the release of these neurotransmitters, although its mechanism in pain management is not fully understood.
In the U.S., pregabalin is marketed by Viatris under the brand name Lyrica and Lyrica CR (for an extended-release formulation), with generic versions also available.
Therapy snapshot
| Treatment name | Pregabalin |
| Usage | Used off-label in MS to ease neuropathic pain and spasticity |
| Administration | Oral capsules, solution, and extended-release tablets |
Who can take pregabalin?
According to international guidelines, pregabalin is considered a first-line treatment for managing neuropathic pain. Although not specifically approved for MS, pregabalin is often also used as a first-line option for neuropathic pain in this patient population.
The therapy may also be prescribed to treat spasticity in people with MS, particularly when conventional therapies are ineffective or intolerable.
According to the prescribing label for its approved indications, pregabalin should not be used by people with a history of an allergic reaction to pregabalin or any of its ingredients.
How is pregabalin administered?
Pregabalin is available as an oral solution, oral capsules, and extended-release oral tablets that allow for less frequent dosing. The solution and capsule formulations are usually taken two or three times daily, with or without food. The extended-release formulation is taken once daily after an evening meal.
Because pregabalin is not specifically approved for MS, there is no single established dosing regimen. But as in its approved indications, the dose is typically started low, at 150 or 165 mg/day, and increased slowly to find one that controls symptoms without intolerable side effects. The total daily dose ultimately reaches up to 600 or 660 mg.Â
Abrupt discontinuation can cause serious side effects, so the treatment should always be tapered gradually under medical supervision.Â
Pregabalin side effects
The most common side effects of pregabalin for its approved indications include:Â
- dizziness
- drowsiness
- dry mouth
- swelling
- blurred vision
- weight gain
- difficulties with concentration and attention
The medication also comes with warnings for potentially serious adverse events, including:
- allergic reactions and angioedema, or swelling in the deeper layers of the skin, which may affect the airways and be life-threatening
- increased risk of suicidal thoughts and behavior
- dangerously slow and shallow breathing
However, the frequency of these and other side effects in the MS population is not definitively established.
Patients should always tell their medical providers about any other medications they’re using or health conditions they have, as this may affect the dosing regimen or influence pregabalin’s safety.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
