Pregabalin is prescribed for people whose nerve pain has not responded to other medicines. Nerve pain medicines do not work for everyone and often they do not relieve pain completely when they do work. 

Pregabalin helps lessen the pain you are feeling so that you are able to perform your daily activities and have a better quality of life.

Start low

People taking pregabalin for nerve pain usually start the medicine at a low dose of 25 to 75 mg taken once daily at bedtime. Low doses are less likely to cause side effects such as daytime sleepiness.

Go slow

Your GP might increase your initial single daily dose of pregabalin to twice daily after 3–7 days, and doses may be increased every 3–7 days if necessary. Your GP will decide about increasing the dose after observing how you have already responded to the medicine and considering how well you tolerate pregabalin.

Increasing the dose of pregabalin slowly helps prevent unwanted side effects and assists in finding the right dose for you.

The right dose is different for everyone and your GP will work with you to find the dose that works best for you.

Give it a fair go

Don’t expect pregabalin to work straight away. Although you may experience some pain relief within the first few weeks of treatment the full benefit takes longer as the dose is increased to effective levels and may take up to 1 month. Not all medicines work for everyone and you may experience little or no benefit from taking this medicine. Do not stop taking pregabalin suddenly unless your GP has told you to, as stopping this medicine suddenly may cause unwanted side effects (called withdrawal side effects).

Monitor

Monitoring how your body responds to pregabalin is important, not just when you start but also as you continue to take the medicine. Talk to your GP if you have questions or concerns about your nerve pain and pregabalin.

Review regularly

You may need to see your GP regularly when you start taking pregabalin for nerve pain. If you’ve given pregabalin a fair go and your symptoms are not improving, go back to your GP. Don’t stop your medicines without speaking with your doctor first. You may need to try a different medicine for nerve pain before you find the one that works for you. 

Some medicines, when taken with pregabalin, may increase your chances of experiencing side effects and can be harmful. These medicines include:

• pain relievers called opioid analgesics (eg, oxycodone, morphine or codeine)
  
• medicines used to treat anxiety (eg, lorazepam)
  
• medicines used to treat allergies (antihistamines)
  
• medicines used to treat certain psychiatric disorders (eg, olanzapine, quetiapine or risperidone).
  

Your GP or pharmacist can explain what you may need to do if you take any of these medicines and also need to take pregabalin. This could mean changing the amount of medicine you take, or taking a different medicine. Make sure you tell your GP about all the medicines you are taking. Keep a list or use the MedicineWise app on your smart phone to help keep a track of your medicines.

If you’re unsure about what medicines you are taking, ask your GP or pharmacist.

It is also important to be aware of the following risks when taking pregabalin.

• Pregabalin may cause dizziness and drowsiness in some people – do not drive or operate machinery if you experience these symptoms.
  
• Pregabalin may increase suicidal thoughts or worsen symptoms of depression.
  
• Pregabalin may increase dizziness or drowsiness if combined with alcohol.

If you have kidney problems or have been diagnosed with renal impairment or disease, it is important to tell your GP about this before you start taking pregabalin. Your dose of pregabalin may need to be adjusted by your GP.

You may experience side effects while taking pregabalin. The common side effects of pregabalin include:

• dizziness
  
• drowsiness
  
• confusion
  
• blurred vision
  
• tremor
  
• unsteadiness when walking
  
• weight gain
  
• constipation
  
• dry mouth.
  

For a complete list of side effects, please search the Medicine Finder for the Consumer Medicine Information (CMI) leaflet. Some side effects may get better over time, while others such as dizziness and drowsiness may last as long as you take the medicine.

Nerve pain is often difficult to treat. Regular review with your GP will help you to work out what’s right for you. Medicines are just one piece of the puzzle in figuring out what works best for you and your nerve pain. Other pieces of the puzzle include:

• staying active and eating a balanced diet to maintain your physical wellbeing
  
• setting realistic goals for managing your nerve pain
  
• joining a pain support group
  
• trying cognitive behavioural therapy (CBT)
  
• identifying triggers that impact your pain
  
• pacing physical therapies around your daily activities
  
• recognising the importance of routinely taking your medicine.
  

Find out more about managing nerve pain

• Australian Pain Management Association
  
• NSW ACI Pain Management Network
  
• Veterans’ Mates Recovering from pain

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Dworkin RH, O'Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007;132:237-51. 

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