Side-effect warning for pregabalin in neuropathic pain

Prescribing pregabalin for neuropathic pain significantly increases the risks of weight gain, somnolence, dizziness, oedema, fatigue and visual disturbances, researchers have warned.

Clinicians should be cautious about prescribing pregabalin and should consider whether its benefits outweigh potential harms in individual patients. | DR P. MARAZZI/SCIENCE PHOTO LIBRARY
Clinicians should be cautious about prescribing pregabalin and should consider whether its benefits outweigh potential harms in individual patients. | DR P. MARAZZI/SCIENCE PHOTO LIBRARY

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.

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