Abuse Potential of Pregabalin

Background Several case reports and epidemiological studies have raised concern about the abuse potential of pregabalin, the use of which has increased substantially over the last decade. Pregabalin is, in some cases, used for recreational purposes and it has incurred attention among drug abusers for causing euphoric and dissociative effects when taken in doses exceeding normal therapeutic dosages or used by alternative routes of administration, such as nasal insufflation or venous injection. The magnitude of the abuse potential and the mechanism behind it are not fully known. Objective The aim of this study was to present a systematic review of the data concerning the abuse potential of pregabalin. Methods We performed a systematic literature search and reviewed the preclinical, clinical and epidemiological data on the abuse potential of pregabalin. Results We included preclinical (n = 17), clinical (n = 19) and epidemiological (n = 13) studies addressing the abuse potential of pregabalin. We also reviewed case reports (n = 9) concerning abuse of pregabalin. The preclinical studies indicated that pregabalin possesses modulatory effects on the GABA and glutamate systems, leaving room for an abuse potential. Further, clinical studies reported euphoria as a frequent side effect in patients treated with pregabalin. The majority of case reports concerning abuse of pregabalin involved patients with a history of substance abuse and, similarly, epidemiological studies found evidence of abuse, especially among opiate abusers. Conclusions Overall, the available literature suggests an important clinical abuse potential of pregabalin and prescribers should pay attention to signs of abuse, especially in patients with a history of substance abuse. Key Points Preclinical, clinical and epidemiological studies have raised concern about the abuse potential of pregabalin. This concern is further supported by case reports about pregabalin being used in doses that exceed normal therapeutic dosages. Euphoria is a frequent side effect of treatment with pregabalin and this may be of special importance to the abuse potential of pregabalin. Clinicians should be cautious when prescribing pregabalin, especially to patients with a history of substance abuse. & Ole Schjerning [email protected] 1 Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark 2 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark 3 Danish Health and Medicines Authority, Copenhagen, Denmark 4 Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark 5 Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense, Denmark 6 Centre for Schizophrenia, Brandevej 5, 9220 Aalborg, Denmark CNS Drugs (2016) 30:9–25 DOI 10.1007/s40263-015-0303-6