Pregabalin (Lyrica)

[juliob]

@juliob, how's your taper going?

I've just been prescribed 2x50 mg Pregabalin per day and an worried it might spike my tinnitus.

I didn't get tinnitus from lower doses but only when I reached 300 mg. I almost always had a spike 1 hour after my afternoon dosage (second 150 mg intake).

Unfortunately, I might need higher doses to deal with burning brain from benzo tolerance. Some ENTs specialized in tinnitus where I live even prescribe Pregabalin for it.

I am still not tapering off Lyrica and using 225 mg daily. I am switching ADs (Sertraline to Fluvoxamine) and keeping the other treatments the same to not confound stuff.

Thank God my tinnitus is the same volume-wise, and it seems even less intrusive.

I intend to taper off Lyrica once I find my Luvox sweet spot.

 

[Sayeed]

Is Gabapentin less ototoxic? My psychiatrist suggested switching to it due to my complaints.

It's a bummer as Pregabalin is helping me a bunch with other symptoms from benzo tolerance/withdrawal.

I take Gabapentin. No adverse effect on my tinnitus. I take 400 mg twice a day.

 

[juliob]

So... any new inputs on this? I am over the fence on updosing it as it helps with benzo tolerance/withdrawal symptoms.

 

[AVIYT]

I wouldn't take Pregabalin. I continue to blame it for my tinnitus. And even if I were to get tinnitus later in life, at least I'd just have that. Pregabalin also ruined my memory, vision, gave me terrible side effects and intrusive thoughts... terrible stuff.

 

[juliob]

I am aware that I will need to taper it slowly after being on 225 mg for more than 2 months. It helps me a bunch with my worst benzo tolerance symptoms but I don't want to gamble regarding tinnitus.

 

[Taw]

I am aware that I will need to taper it slowly after being on 225 mg for more than 2 months. It helps me a bunch with my worst benzo tolerance symptoms but I don't want to gamble regarding tinnitus.

My neurologist said to take 150 mg a day for 3 months, instead of Dulotexine, which gave me horrible side effects. Hope it works better with this one.

 

[juliob]

My neurologist said to take 150 mg a day for 3 months, instead of Dulotexine, which gave me horrible side effects. Hope it works better with this one.

What do you take Pregabalin for?

I started taking PQQ yesterday and I am thinking I am going to like this supplement.

 

[kingsfan]

I don't have any experience with Pregabalin, but Gabapentin increased my tinnitus while I was on it. It went back to normal after discontinuing. You'll probably just have to try a low dosage first and see what happens.

 

[Taw]

What do you take Pregabalin for?

Continuous burning pain from noxacusis.

 

[Nick47]

I didn't get tinnitus from lower doses but only when I reached 300 mg. I almost always had a spike 1 hour after my afternoon dosage (second 150 mg intake).

At higher doses Pregabalin closes potassium channels. Read up.

I would avoid it as it's not the same MoA as Gabapentin. No wonder it has no support. We didn't really know until post 2018.

 

[momus]

I've been taking 400-800 mg of Gabapentin nightly for 6-7 years, no problems as yet but everyone is different. It seems to have helped the nephropathy in my hands and plays well w/ other medications. I research every drug thoroughly before taking it. This has caused me to switch doctors three times during the last 2 months because, surprise, they refused to listen to my tinnitus concerns after researching the meds they were fixated on prescribing.

My medical people in Albuquerque were nurse practitioners, which I much prefer to doctors, and they saw me at a First Nation Tribal Healthcare facility. It was the best health care I've ever had, mainly because they would listen. We would work together to find meds that didn't cause issues w/ tinnitus or my other health issues. You would think that would be the norm, but now I know it's the exception.

 

[Nick47]

I've been taking 400-800 mg of Gabapentin nightly for 6-7 years, no problems as yet but everyone is different. It seems to have helped the nephropathy in my hands and plays well w/ other medications. I research every drug thoroughly before taking it. This has caused me to switch doctors three times during the last 2 months because, surprise, they refused to listen to my tinnitus concerns after researching the meds they were fixated on prescribing.

My medical people in Albuquerque were nurse practitioners, which I much prefer to doctors, and they saw me at a First Nation Tribal Healthcare facility. It was the best health care I've ever had, mainly because they would listen. We would work together to find meds that didn't cause issues w/ tinnitus or my other health issues. You would think that would be the norm, but now I know it's the exception.

It seems people fall into subgroups.

Given this is the Pregabalin thread and as we unravel more about tinnitus, I wanted to shed some light on how something related to Gabapentin doesn't seem to have any successful studies in tinnitus. Not even case studies really.

It may boil down to recent findings:

In contrast, the structurally related gabapentinoid, pregabalin, does not activate KCNQ2/3, and at higher concentrations (≥10 µM) is inhibitory.

Gabapentin Is a Potent Activator of KCNQ3 and KCNQ5 Potassium Channels

In other words, if you are going to choose between the two, Gabapentin is a better option.

 

[juliob]

At higher doses Pregabalin closes potassium channels. Read up.

I would avoid it as it's not the same MoA as Gabapentin. No wonder it has no support. We didn't really know until post 2018.

I have already been on Pregabalin for more than a year. Is it an option to do a direct switch or would I need to taper Pregabalin anyway?

 

[Nick47]

have already been on Pregabalin for more than a year. Is it an option to do a direct switch or would I need to taper Pregabalin anyway?

That is a question for your GP. I would think a straight switch but Gabapentin would need to be taken 3-4 times a day as it has a much shorter half life.

 

[StoneInFocus]

Chronic pain is a common public health problem and remains an unmet medical need. Currently available analgesics usually have limited efficacy for the treatment of chronic pain, including neuropathic pain and persistent inflammatory pain, or they are accompanied by many adverse side effects. The voltage-gated calcium channel blocker (pregabalin) and potassium channel openers (flupirtine and retigabine) have been widely used for the management of chronic pain, but their effectiveness in combination is unclear. In this research, we evaluated the antinociceptive effects of pregabalin in combination with flupirtine or retigabine in carrageenan-induced inflammatory pain and paclitaxel-induced peripheral neuropathy in mice using the von Frey test. Isobolographic analysis indicated that pregabalin exerted synergistic antinociceptive effects when combined with flupirtine or retigabine in neuropathic and inflammatory pain models. Furthermore, the antinociceptive effects of pregabalin, flupirtine/retigabine, and their combinations were significantly attenuated by the Kv7 channel blocker XE991. The favored dose ratio between pregabalin and flupirtine/retigabine in combinations was also investigated. Finally, we evaluated the motor coordination of their combinations using the rotarod test, and the outcomes underpinned their safety. Collectively, our results support the potential use of pregabalin in combination with flupirtine or retigabine to alleviate chronic pain.

Pregabalin can interact synergistically with Kv7 channel openers to exert antinociception in mice

 

[JayZee]

Pregabalin can interact synergistically with Kv7 channel openers to exert antinociception in mice

Why would researchers investigate adding two drugs (Flupirtine or Retigabine) that have already been discontinued or banned due to bad side effects?

 

[StoneInFocus]

Why would researchers investigate adding two drugs (Flupirtine or Retigabine) that have already been discontinued or banned due to bad side effects?

The answer is in the article.

"Although retigabine and flupirtine (the first-generation Kv7/KCNQ channel openers) have
been discontinued from the market because their structure-related adverse side effects, targeting Kv7/KCNQ channels still presents a promising strategy for therapy of chronic pain (Liu et al., 2021)."

 

[Gnl1986]

I've been on Pregabalin for 7 years. I have developed nerve issues that look very similar to MS, and I swear Pregabalin is the cause of it!

I take around 900 mg a night, sometimes more.

I find Pregabalin makes my tinnitus much worse when I take higher dosages.

I have been trying to reduce how much I take, but because I take it to help fall asleep, I reduce my dose by taking more Zopiclone.

When I run out of Zopiclone early, I boost my Pregabalin back up, and the cycle continues month after month. I have tried to quit Pregabalin for years.

When I try quitting Pregabalin, I get painful burning pins and needles through my whole body. It's worse than benzo withdrawal. I've wanted Xanax to come off of them but can't get my doctor to agree.

Pregabalin obviously works on the GABA receptors, and GABA imbalance leads to tinnitus. Zopiclone also affects GABA levels.

My tinnitus is less when I'm down around 450 mg of Pregabalin with 23 mg - 30 mg of Zopiclone. I do get sleepy the next day. Having naps also help with tinnitus.

I think most of the drugs mentioned on Tinnitus Talk greatly influence GABA levels which causes tinnitus; too much GABA will give you more tinnitus. But the calming properties may relax enough to decrease tinnitus. Be careful not to take too much which causes too much GABA.

 

[Nick47]

My tinnitus is less when I'm down around 450 mg of Pregabalin

This is because at higher doses Pregabalin closes potassium channels.

 

[StoneInFocus]

I wonder why there are so many horror stories of Lyrica compared to other calcium channel blockers.

Pregabalin blocks α2δ subunit-containing voltage-gated calcium channels. Are these particular channels expressed in parts of the body where its blockage results in relatively more negative effects compared to blocking the calcium channels in other parts of the body?

So far instance, maybe α2δ subunit-containing voltage-gated calcium channels are quantitatively more expressed in the central nervous system and blocking them results in nasty tinnitus worsening, and maybe L type calcium channels are more predominantly expressed in the heart and smooth muscle so blocking them results in more heart related effects = better option for tinnitus & hyperacusis sufferers? Hence why Nifedipine is often prescribed to treat heart and blood flow related illnesses?

Maybe it has to do with tissue distribution, or in other words where the drugs 'end up' in the body, but I don't really know much about that.