Gabapentinoids are considered as a first-line treatment for neuropathic pain, however, Gabapentinoids are used for off-label conditions more than that for on-label use. This leads to increasing the risk of respiratory depression, especially when combined with opioids.
Pregabalin V Gabapentin:
- Uses: Both Pregabalin and gabapentin are antiepileptic drugs to treat nerve pains. In addition, they act as an adjunct treatment for seizures and postherpetic neuralgia.
Furthermore, Pregabalin is used to manage the pain related to fibromyalgia and neuropathic pain associated with diabetes.
Gabapentin may be used to treat nerve pain caused by shingles and for restless legs syndrome (RLS). Also, it has several off-label uses including the management of neuropathic pain, anxiety, insomnia, vertigo, skin itching, menopausal conditions hot flashes, migraine, and bipolar disorder.
- Whilst, Pregabalin has been classified as a controlled substance (have some potential for abuse and psychological dependence), Gabapentin is not. However, it was found that the Gabapentin abuse rate ranged from 40% to 65% in patients with previous drug abuse history or patients with prescription of the drug and about 15% to 22% in patients who abuse opioids.
- Absorption: Both Pregabalin and Gabapentin are similar in structure, however, Pregabalin may have better absorption (quickly and completely absorbed), and easier transport across cell membranes.
is extended from the small intestine to the proximal colon while Gabapentin absorption is limited to the small intestine.
Pregabalin reaches peak blood concentration within an hour post-dose while Gabapentin reaches peak blood concentration within 3 hours post-dose.
(the amount of drug in the patient’s system): Pregabalin has the advantage that its bioavailability is constant regardless of the dose, while Gabapentin’s bioavailability changes with the increase of the dose as it decreases from 60% to 33% per day.
- Metabolism and Excretion: Mostly done by the kidney, but may cause renal failure in overdoses. Some cases reported drug-induced hepatotoxicity although they are not metabolized by the liver.
- Switch from Pregabalin to Gabapentin or vice versa: Neither Pregabalin can be used as an alternative for Gabapentin nor Gabapentin can be used as an alternative for Pregabalin unless
prescribed by the doctor, although both of them are Gabapentinoids.
Both Pregabalin and Gabapentin have common side effects such as dizziness, drowsiness, headache, memory or concentration issues, tremors, impaired balance, and vision problems (like blurred vision or double vision).
However, side effects more common with Pregabalin are dry mouth, edema (swelling), constipation, weight gain, or enlarged breast.
Other side effects are more common with Gabapentin like fever, risk of viral infections, difficulty in speaking, abnormal eye movements.
- Addiction: Pregabalin has higher addiction potential liability than Gabapentin due to its faster absorption and onset of action.
- Drug Interactions: both Pregabalin and Gabapentin have similar drug interactions however Gabapentin may also interact with non-steroidal anti-inflammatory drugs (NSAIDs) such as Diclofenac, Ibuprofen, and Naproxen.
- Mechanism of action: Both Pregabalin and Gabapentin have the same mechanism of action (they act in the same way) through the central nervous system.
- Misuse: Both Pregabalin and Gabapentin have been reported to enhance sociability feelings, euphoria (too much laugh), relaxation, and also stimulate psychological side effects of other drugs. The abuse potential of Pregabalin is higher than that of Gabapentin. Both Pregabalin and Gabapentin are associated with misuse, abuse, and withdrawal symptoms on stopping or reducing the dose of the drug.
Pregabalin V Gabapentin withdrawal symptoms:
- Insomnia (cannot sleep)
- Impairment of muscle movements
Pregabalin withdrawal symptoms:
- Sleep issues
Gabapentin toxicity is more likely in patients with chronic kidney disorders. Patients on dialysis (a process of removal of waste products and excess fluids from the blood in patients with impaired kidney functions) have a higher toxicity risk. Patients on hemodialysis (entire blood circulation outside the body using a certain machine as a dialyzer to filter wastes, fluids, and salts from the blood) might require additional doses after dialysis because this process removes about 50-60% of Pregabalin and about 30% of Gabapentin.
Pregabalin V Gabapentin: Which is best for you?
Pregabalin and Gabapentin are both similar in structure, mechanism of action, and conditions approved to treat. However, according to studies Pregabalin is suggested to have more advantages than Gabapentin especially for certain types of pain.
The decision of drug choice in Gabapentinoids is referred to the health care provider responsible for you, concerning the medical condition, medical history, symptoms, age, lifestyle, other drugs, food type, and physical activities.
That’s why you should never share your prescription with other patients.