Last updated July 22, 2022, by Marisa Wexler, MS
✅ Fact-checked by Inês Martins, PhD
Pregabalin is an anticonvulsant that is approved by the U.S. Food and Drug Administration to treat partial onset seizures, fibromyalgia, and nerve pain associated with diabetes, spinal cord injury, or shingles infection.
The medication is not formally approved for use in people with multiple sclerosis (MS), but is often used off-label in these patients to manage spasticity and nerve pain. This type of pain, also called neuropathic pain, results from damage to the nervous system and manifests in the form of painful sensations, including pins and needles, squeezing sensations, or a feeling of burning or stabbing in the skin.
How does pregabalin work?
In MS, inflammation causes damage to the nervous system and disrupts normal neurological activity, which ultimately results in the disease’s symptoms. Sometimes, damage can cause the nerves that sense pain to be overactive, resulting in the sensation of pain even though nothing is physically damaging the body. It can also interfere with the nerves that coordinate movement, leading to involuntary muscle contractions and spasms.
Pregabalin’s exact mechanism of action is incompletely understood, but the therapy is believed to bind to proteins called voltage-gated calcium channels on nerve cells. This reduces the release of certain signaling molecules (neurotransmitters) from the nerves, which ultimately lowers the intensity of pain signals and muscle contractions.
Who should not use pregabalin?
Pregabalin should not be used by individuals with a known allergy to the medication.
How is pregabalin administered in MS?
Pregabalin is available as an oral solution and in capsules at a variety of dosage strengths. It is usually taken in two or three doses per day and can be taken with or without food.
Patients are generally started on a relatively low dose, around 75 mg once or twice per day, and then doses are increased to find a dose that controls symptoms without unacceptable tolerability problems. Doses may be increased up to 300 mg/day within one week and to 600 mg/day after an additional two to four weeks.
Because the medication is eliminated primarily via the kidneys, dose adjustments may be needed for patients with reduced kidney function.
Also, when stopping treatment with pregabalin, the dosage should be gradually reduced over the course of at least one week to avoid side effects associated with abrupt discontinuation.
Common side effects of pregabalin
The most common side effects of pregabalin include:
- dry mouth
- blurred vision
- weight gain
- difficulty with concentration and attention
Pregnancy and breastfeeding
An observational study of over 2,700 pregnancies indicated that taking pregabalin during the first trimester of pregnancy slightly increased the risk of major congenital malformations (birth defects). It is generally recommended that pregabalin should only be used in pregnancy if the benefits of treatment clearly outweigh the risk to the fetus.
Pregabalin is secreted in human breast milk, and animal studies have indicated that exposure to pregabalin in milk can increase the risk of cancer in nursing infants. Consequently, breastfeeding is not recommended for patients treated with pregabalin.
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