Prescribers 'should be aware of pregabalin's numerous side-effects' when considering the drug as a treatment option for neuropathic pain, say the authors of a new meta-analysis published in the BMJ.
In their systematic review and meta-analysis of 28 randomised, placebo-controlled trials in 6087 adults with neuropathic pain, Igho Onakpoya and colleagues found that pregabalin significantly increased the risk of adverse events compared with placebo (relative risk 1.33 [95% CI 1.23–1.4], p<0.00001).
The risks of experiencing weight gain, somnolence, dizziness, peripheral oedema, fatigue, visual disturbances, ataxia, non-peripheral oedema, vertigo and euphoria were all significantly increased with pregabalin.
As a result, pregabalin was almost twice as likely as placebo to be discontinued because of adverse events (relative risk 1.91 [95% CI 1.54–2.37], p<0.00001).
Pregabalin did have beneficial effects on some symptoms of neuropathic pain.
Patients who took the drug reported significant reductions in pain and sleep interference scores compared with placebo (p < 0.00001 for both). However, the authors highlight that the overall quality of the evidence was low and the trials were of short duration.
The trials included patients with a range of neuropathic pain conditions, including diabetic peripheral neuropathy, postherpetic neuralgia, herpes zoster, sciatica, poststroke pain and spinal cord injury-related pain.