Short-term harms of pregabalin
These harms appear within hours of taking more than the prescribed dose. Some may also affect people using the medication on prescription in the first days, but they are more severe and more dangerous with misuse:
- Severe dizziness and unsteady walking, with a risk of falls and fractures, especially in older adults.
- Heavy drowsiness and slowed reactions, which raise the risk of road and workplace accidents.
- Blurred or double vision.
- Confusion and difficulty concentrating and speaking, and sometimes agitation or hallucinations at high doses.
- Nausea, dry mouth and constipation.
Why is mixing pregabalin with tramadol and opioids so dangerous?
Pregabalin alone rarely stops breathing in a healthy person, but the picture changes completely when it is mixed with other substances that depress the nervous system. In December 2019, the US Food and Drug Administration warned that pregabalin and gabapentin can cause serious breathing problems in people who also take opioids or other sedatives, and in people with chronic lung disease and older adults.
| Substance mixed | What happens? |
|---|---|
| Tramadol and other opioids | Double depression of breathing and consciousness, and a clear rise in the risk of death. Pregabalin has been found in a notable share of opioid deaths in several countries. |
| Alcohol | Severe drowsiness, confusion and loss of consciousness, with an effect on breathing. |
| Benzodiazepines such as Xanax and Rivotril | Excessive sedation, slow breathing and temporary memory loss. |
| Sleeping pills and sedating antihistamines | Increased drowsiness and dizziness, and a risk of falls and choking during sleep. |
Long-term harms of pregabalin on the body
With repeated use over weeks and months, especially in large amounts and without follow-up, harms appear that affect different body systems:
| System | Possible harms |
|---|---|
| Nervous system | Chronic dizziness, loss of balance, tremor, and slowed movement and reactions. |
| Weight and metabolism | Increased appetite and weight gain, which may also affect blood sugar control in people with diabetes. |
| Limbs and circulation | Swelling in the feet and hands, which may worsen in people with heart failure. |
| The eyes | Blurred or double vision, and changes in the visual field in some patients. |
| Muscles | Muscle pain and, in rare cases, muscle damage that shows up as a raised CK enzyme in blood tests. |
| Sexual function | Erectile dysfunction and reduced sexual desire in some users. |
| Digestive system | Constipation, bloating and dry mouth. |
Harms of pregabalin on memory and mental health
Pregabalin suppresses nerve activity, so with misuse its effect extends to thinking and mood:
Forgetfulness, poor attention and slowed thinking, which students and workers notice in their performance.
Mood swings and irritability, and depression or anxiety may increase between doses or when the medication runs low.
The official leaflet warns that epilepsy medications, including pregabalin, may raise the risk of suicidal thoughts in a small number of patients. Any thought of this kind calls for seeking help immediately.
Heavy sleep at first, then disturbed sleep with dependence, especially when the usual dose is late.
If the person already has a mental health condition such as anxiety or depression, pregabalin misuse masks the symptoms for a while and then complicates their treatment. This is called dual diagnosis, and it requires treating both conditions together.
Can pregabalin cause a serious allergic reaction?
In rare cases pregabalin can cause sudden swelling of the face, lips, tongue and throat, known as angioedema, which can block breathing. This is an emergency that needs an ambulance immediately, whatever the reason for using the medication, whether prescription or misuse. A severe skin rash or blistering may also appear in rare cases.
Harms of pregabalin for teenagers and young adults
Some young people pass pregabalin around as “mood pills” or “staying-up pills,” believing it is milder than street drugs because it is a medication. But the brain at this stage is still maturing, especially the areas responsible for self-control and decision-making, so it is more sensitive to the effect of depressant substances and quicker to develop dependence. On top of this come declining school performance, motorbike and car accidents, and moving on to mixing the medication with tramadol or other substances within friend groups.
Who is most at risk of the harms of pregabalin?
- People who take tramadol or any other opioids at the same time.
- People with kidney disease, because the drug leaves the body through the kidneys and builds up when they are weak.
- Older adults, because of a higher risk of dizziness, falls and build-up of the drug.
- People with chronic lung disease such as COPD, because of the risk of respiratory depression.
- People with heart failure, because of limb swelling and fluid retention.
- Teenagers and young adults, because the brain is still developing and is more affected by depressant substances.
Harms of pregabalin in pregnancy and breastfeeding
The official leaflet states that pregabalin may harm the fetus, and some studies point to a possible slight increase in birth defects, although the evidence is still inconclusive. It also passes into breast milk, so breastfeeding is not recommended while using it.
At the same time, a pregnant woman who takes it on prescription must not stop it suddenly, especially if it is for epilepsy, because the seizures themselves can harm both mother and fetus. The right step is to see the doctor immediately to set up a safe plan. The rule is the same for medical use and for misuse.
Why is pregabalin more dangerous for older adults?
Older adults need special caution with pregabalin even when it is taken on prescription, because kidney function naturally declines with age and the drug stays in the body longer. Dizziness and loss of balance increase, which raises the risk of falls and hip fractures, and confusion may appear that is sometimes mistaken for dementia symptoms. If an older person also takes other sedating medications or opioid painkillers, or has chronic lung disease, the risk of slow breathing rises. For this reason a doctor should review their full medication list regularly, and no additional sedating medication should be given without consultation.
Do the harms of pregabalin go away after stopping?
Most harms of pregabalin can improve after gradual discontinuation under medical supervision: dizziness and blurred vision ease, concentration and memory return gradually, limb swelling lessens, and normal weight can be regained over time. Harm caused by accidents or by oxygen deprivation during a severe overdose may need separate treatment. The earlier treatment begins, the better the chances of full recovery.
Signs of pregabalin poisoning or overdose: call an ambulance on 123 immediately
- Extreme drowsiness, or difficulty waking the person, with no response to calling
- Slow, shallow, or irregular breathing, especially if the medicine was mixed with tramadol, opioids, or alcohol
- Blue or pale lips and fingernails
- Severe confusion, agitation, hallucinations, or unintelligible speech
- Seizures, or sudden swelling of the face, lips, and throat with difficulty swallowing or breathing
Call an ambulance on 123 immediately, place the person on their side so they do not choke, do not give them anything by mouth, stay with them until help arrives, and keep the medicine packs they took to show the doctor. If opioids or tramadol were part of the mixture, the emergency team may use the drug naloxone to reverse their effect.
Call the ambulance 123
21Social and financial harms