Pregabalin withdrawal

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Pregabalin Withdrawal: Insights from Recent Research

Introduction to Pregabalin Withdrawal

Pregabalin, a medication commonly used for neuropathic pain, epilepsy, and generalized anxiety disorder, has been increasingly scrutinized for its withdrawal effects. Withdrawal symptoms can occur even in patients taking regular therapeutic doses, leading to significant physical and psychiatric complications 410.

Efficacy of Pregabalin in Treating Withdrawal Symptoms

Alcohol Withdrawal Syndrome (AWS)

Several studies have explored the efficacy of pregabalin in treating alcohol withdrawal syndrome (AWS). A multi-center, randomized trial compared pregabalin with lorazepam and tiapride, finding that pregabalin significantly reduced withdrawal symptoms, particularly headaches and orientation issues, and had higher retention rates in treatment . Another randomized placebo-controlled trial, however, did not find significant differences between pregabalin and placebo in reducing AWS symptoms, though both were well-tolerated .

Opioid Withdrawal Syndrome (OWS)

Pregabalin has also been studied for its potential in treating opioid withdrawal syndrome (OWS). A randomized single-blind study found that pregabalin was effective in reducing craving, anxiety, and depression associated with OWS, with better patient retention compared to clonidine . Additionally, case reports suggest that pregabalin can alleviate withdrawal symptoms in opiate-dependent patients, although more extensive studies are needed .

Psychiatric and Physical Symptoms of Pregabalin Withdrawal

Psychiatric Symptoms

Withdrawal from pregabalin can lead to various psychiatric symptoms, including insomnia, anxiety, and even delirium. Case series and literature reviews have documented instances where patients without prior psychiatric disorders developed significant psychiatric symptoms after abrupt discontinuation of pregabalin 45. These findings highlight the need for careful dose reduction and monitoring during discontinuation.

Physical Symptoms

Physical symptoms of pregabalin withdrawal can include gastrointestinal distress, tachycardia, and headaches. In a case report, a patient experienced acute withdrawal symptoms postoperatively after stopping pregabalin, underscoring the importance of managing withdrawal even in clinical settings .

Effects on Testicular Function

An experimental study on rats revealed that pregabalin administration and subsequent withdrawal affected testicular structure and function. Pregabalin administration led to decreased testosterone levels and increased luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. Withdrawal resulted in a rebound effect, with increased testosterone and decreased LH and FSH levels, along with significant oxidative stress .

Conclusion

Pregabalin withdrawal can lead to a range of psychiatric and physical symptoms, even in patients taking regular therapeutic doses. While pregabalin shows promise in treating withdrawal symptoms from substances like alcohol and opioids, its own withdrawal effects necessitate careful management. Future research should focus on developing guidelines for safely discontinuing pregabalin to minimize withdrawal symptoms and ensure patient safety.

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Most relevant research papers on this topic

Pregabalin for the Treatment of Drug and Alcohol Withdrawal Symptoms: A Comprehensive Review

Pregabalin shows promising evidence for treating physical dependence and associated withdrawal symptoms from opioids, benzodiazepines, nicotine, cannabinoids, and alcohol, but caution is needed in this patient population.

Systematic ReviewVery Rigorous Journal

2016·

44citations

·R. Freynhagen et al.

Pregabalin, tiapride and lorazepam in alcohol withdrawal syndrome: a multi-centre, randomized, single-blind comparison trial.

Pregabalin is a more effective treatment for alcohol withdrawal syndrome than tiapride and lorazepam, with potential for further investigation.

RCTRigorous JournalHighly Cited

2010·

75citations

·G. Martinotti et al.

[A randomized single blind study of the efficacy of pregabalin in the treatment of opioid withdrawal syndrome].

Pregabalin is an effective and safe treatment for opioid withdrawal syndrome, with better patient tolerability and higher detoxification completion rates compared to clonidine.

RCT

2016·

11citations

·E. Krupitsky et al.

Pregabalin withdrawal in patients without psychiatric disorders taking a regular dose of pregabalin: A case series and literature review

Pregabalin withdrawal can occur even with regular doses and short-term use, requiring careful reduction and monitoring of withdrawal symptoms.

Rigorous Journal

2021·

10citations

·Hayahito Ishikawa et al.

Delirium After Pregabalin Withdrawal

Pregabalin is a γ-amino butyric acid analogue drug that is used in fibromyalgia, neuropathic pain associated with diabetic peripheral neuropathy, spinal cord injury, and postherpetic neuralgia. Symptoms reported in association with pregabalin withdrawal include insomnia, gastrointestinal distress, tachycardia, and headache. This case report describes a 68-year-old patient who developed delirium after experiencing pregabalin withdrawal. Clinicians should be aware of the possibility of pregabalin withdrawal delirium.

Case Report

2021·

7citations

·A. Çalışkan et al.

Pregabalin administration and withdrawal affect testicular structure and functions in rats

Pregabalin administration negatively affects testicular morphometry, gonadotrophic and sex hormones in rats, but these effects rebound and cause significant oxidative stress when the drug is withdrawn.

RCTAnimal Study

2020·

6citations

·Mohammad Salem Hareedy et al.

Efficacy and safety of pregabalin in the treatment of alcohol withdrawal syndrome: a randomized placebo-controlled trial.

Pregabalin is relatively safe for treating alcohol withdrawal syndrome during detoxification, but its efficacy is not significantly different from placebo.

RCT

2012·

38citations

·A. Förg et al.

[Pregabalin for the reduction of opiate withdrawal symptoms].

Pregabalin effectively reduces opiate withdrawal symptoms in a patient with opiate dependence, potentially aiding in successful relapse treatment.

Case Report

2012·

16citations

·N. Kaemmerer et al.

Efficacy and Safety of Once-Daily Controlled-Release Pregabalin for the Treatment of Patients With Postherpetic Neuralgia: A Double-Blind, Enriched Enrollment Randomized Withdrawal, Placebo-Controlled Trial

Pregabalin CR significantly increased time to loss of therapeutic response and improved pain score in postherpetic neuralgia patients, with a comparable safety profile to immediate-release formulations.

RCTLarge Human Trial

2017·

18citations

·C. Huffman et al.

Acute withdrawal in the postoperative setting in a patient taking standard therapeutic doses of pregabalin.

Acute withdrawal symptoms of pregabalin can occur in patients taking therapeutic doses in the postoperative setting, but this has not been previously documented.

Case Report

2023·

3citations

·Caitlin E. Kulig et al.

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