Pregabalin and gabapentin

At a glance

Compared with waiting

In a combined analysis of 101 trials, this group of medicines showed a large difference compared with waiting.

Compared with other treatments

Better than placebo in a few trials. In a trial of 329 people, only the highest pregabalin dose tested beat placebo.

Does it last

In a trial of 153 people who had improved on pregabalin, those who stayed on it relapsed later than those switched to placebo.

What it takes

Daily tablets, prescribed and reviewed by a doctor.

What they are

Pregabalin and gabapentin are related medicines. They were first used for epilepsy and nerve pain. Doctors sometimes prescribe them for anxiety. They are sometimes called gabapentinoids. A doctor decides whether one suits you and at what dose.

What people report

On Reddit, a minority of people say pregabalin or gabapentin helped them more than anything else. Others warn about feeling dependent on them and about withdrawal when stopping. These are reports from people, not trial results.

What the trials show

• Pregabalin worked at the highest dose tested. In a trial of 329 people, only the highest dose beat placebo. Two lower doses did not.
• Staying on pregabalin delayed relapse. In a trial of 153 people who had improved on pregabalin, those who stayed on it for 26 weeks relapsed later than those switched to placebo. Dizziness was more common on pregabalin (11.3% compared with 4.1%).
• Gabapentin: one small trial. In a US trial of 69 people over 14 weeks, gabapentin reduced social anxiety more than placebo. Dizziness, dry mouth and sleepiness were more common.
• Combined results. A Cochrane review found people on these medicines were about 1.6 times as likely to respond as people on placebo. A study that combined 101 trials found a large difference compared with waiting for this group of medicines.
• Guidelines differ. Canada’s guideline lists pregabalin among its first choices and gabapentin as a second choice. The UK guideline (NICE) advises against routinely offering this type of medicine for social anxiety.

What the trials have not answered

• No trial has compared them directly with SSRIs for social anxiety.
• Long-term effects beyond about six months are unknown for social anxiety.

Side effects and risks

• Common: dizziness, sleepiness, dry mouth, unsteadiness, increased appetite and weight gain. Tell your doctor straight away about changes in eyesight or swelling.
• Misuse and dependence. In the UK, pregabalin and gabapentin became Class C controlled drugs in 2019. The government cited rising deaths and concerns about misuse and addiction.
• Mood. In studies of medicines like these, about 1 in 500 people developed suicidal thoughts or behaviour. If that happens, contact your doctor or a crisis line straight away.
• Alcohol adds to the drowsiness. MedlinePlus advises not to drink while taking pregabalin. See alcohol and social anxiety.

Stopping

Do not stop suddenly or change the dose without your doctor. Stopping pregabalin suddenly can cause withdrawal symptoms, including trouble sleeping, nausea, diarrhoea, headaches or seizures. Your doctor can plan a slow reduction.

Medication or therapy?

There is no single ranking. Compared with their own starting point, medicines can look stronger than therapy. Compared with a placebo or waiting, individual CBT made for social anxiety had the largest effect. SSRIs and SNRIs explains why the answer depends on the comparison.

For most people, SSRIs and SNRIs and cognitive therapy for social anxiety are better-tested first steps.