Pregabalin And Alcohol

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KEY TAKEAWAYS

Drinking alcohol while taking Pregabalin results in:

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Reasons For Mixing Pregabalin & Alcohol

Alcohol and pregabalin (Lyrica) are mixed by users when prescribed, such as:

  • Those suffering from epilepsy, fibromyalgia, or chronic pain are prescribed pregabalin, but are also self-medicating with alcohol - leading to unintentional mixing
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However, alcohol is also mixed with pregabalin by street users, for example:

  • Those self-medicating Lyrica for anxiety caused by alcohol abuse
  • Chronic drug and alcohol users who believe poly usage increases each drug's effects
  • Those using Lyrica to avoid the side effects of withdrawal from alcohol

Setting

Reasons For Use

Anxiety from alcohol use

Using pregabalin to manage anxiety from
alcohol abuse while still drinking

Epilepsy, chronic pain, or fibromyalgia
treatment

Pregabalin mixed with alcohol as
self-medication for pain

Using pregabalin to avoid the side effects of
alcohol withdrawal

Using pregabalin to avoid seizures caused by
alcohol withdrawal

Chronic drug users

Believing the combination increases the
effectiveness of each or both drugs

Unintentional mixing

Those prescribed pregabalin are not aware
that combining with alcohol causes potential
side effects

Risks Of Combining Pregabalin With Alcohol

CNS

Lyrica and alcohol combined depress the central nervous system, causing:

  • Lethargy
  • Sedation
  • Respiratory depression [2]

Respiration

Mixing alcohol with Lyrica can lead to respiratory arrest and an increased risk of developing pneumonia or a collapsed lung [3].

Alcohol and pregabalin combined with fentanyl or benzodiazepines can cause respiratory depression [4].

Pre-Existing Liver Issues

In patients with pre-existing non-alcoholic fatty liver disease, 8 days of pregabalin usage combined with occasional alcohol usage resulted in jaundice and elevated liver transaminase levels [5].

Mental Health

Lyrica is typically prescribed for generalised anxiety disorder or convulsions.

As both alcohol and Lyrica depress neurotransmitter activity, the combination counteracts pregabalin's use for anxiety as alcohol increases anxiety after its initial depressive effect on neurotransmitters has worn off.

Those using Lyrica combined with alcohol develop a cycle of:

  1. 1
    Using Lyrica to achieve relief from convulsions or generalised anxiety disorder
  2. 2
    Drinking alcohol
  3. 3
    Going into withdrawal after alcohol consumption ceases
  4. 4
    Continuing to use Lyrica to counteract withdrawals, convulsions and anxiety caused by alcohol

Multiple Medications

Amitriptyline

Amitriptyline and Lyrica combined with alcohol lead to blackouts or a loss of consciousness [6].

Oxycodone

Combining oxycodone and Lyrica with alcohol depresses sympathetic activity, causing cardiac arrest or brain damage [7].

Lisinopril

Angioedema caused by lisinopril and Lyrica interaction is exacerbated by alcohol abuse and can lead to throat constriction and suffocation.

Poly-Drug Use

Opiate street drugs (i.e. marijuana, heroin, and oxycodone) combined with pregabalin and alcohol increase the depressive effects of each drug, potentially causing respiratory depression [8].

Stimulant drugs (i.e. LSD, MDMA, and cocaine) combined with pregabalin and alcohol cause:

  • Overstimulation of the CNS and heart - causing heart attacks or strokes [9]
  • Overdose - users may take more Lyrica mixed with alcohol and stimulants due to not experiencing the expected high caused by the drug and alcohol combination [10]
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Tolerance

Regaining Initial Euphoria

A built-up tolerance to Lyrica stops the user from feeling pregabalin's pleasurable or pain-relieving effects.

This encourages further drinking as the user attempts to recapture the initial pleasurable euphoria and pain-relieving effects of Lyrica and alcohol use combined.

Signs Of Overdose

The body does not show outward signs of overdose (vomiting, seizures, and loss of consciousness) under increasing levels of Lyrica tolerance [11].

Seizures

If the user is prescribed pregabalin for epileptic attacks or convulsions, drinking can result in a status epilepticus (a seizure lasting 30 minutes or longer or a series of seizures where the patient does not regain consciousness between seizures) [12].

Motor Skills

Combining pregabalin and alcohol can cause:

  • Lapses in concentration or blackouts
  • Decreased judgement
  • Motor impairment [13]

At-Risk Groups

Jobs Using Heavy Machinery

Those with jobs that involve high-risk equipment (forklifts, bulldozers or cranes) while mixing pregabalin and alcohol experience risks due to:

  • Drowsiness or impaired cognition leading to incorrectly using equipment
  • Drink/drug driving - particularly of vans, lorries or trucks
  • Convulsions or heart attack whilst operating machinery [14]

Pre-Existing Depression

For those with pre-existing depression, using pregabalin and alcohol concurrently can lead to an increase in suicidal or depressive thoughts [15].

Pregnancy

Taking Lyrica and alcohol while pregnant causes:

  • An 80% increased risk of stillbirth compared to non-drinking mothers [16]
  • Physical birth abnormalities (5.9% of births with pregabalin vs. 4.1% of births without) [17]

Detoxing From Alcohol Alone

Complications when detoxing from alcohol alone while using pregabalin, include:

  • Epilepsy attacks, anxiety, or fibromyalgia and how this will affect timescale and outcomes - lengthens detox time to 10+ days [18]
  • Managing physical chronic pain alongside withdrawal - ensuring that chronic pain is effectively managed during detox to avoid future relapse due to pain
  • Detox medications (benzodiazepines, gabapentin, or quetiapine) interact with pregabalin - alternative medications such as acamprosate or topiramate can take up to 10 days to start working

Special considerations to be in place, once detoxification is complete, include:

  • Ensuring the user does not develop a cross-addiction to pregabalin
  • Ensuring the patient receives adequate secondary pain relief for chronic pain
  • Ensuring future medication prescribed does not interact adversely with pregabalin

Detox From Pregabalin In Alcohol Users

The protocol used by medical practitioners in those who consume, but are not addicted to, alcohol includes:

  • Tapering pregabalin detox over 21-30 days, rather than immediate cessation
  • Prescribing chlordiazepoxide to avoid withdrawal symptoms of pregabalin detox being exacerbated by alcohol use [19]

If doctors are concerned that alcohol usage will affect pregabalin prescription use, they may alternatively prescribe duloxetine or amitriptyline [20].

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Pregabalin For Alcohol Withdrawal

Pregabalin can be used for alcohol detoxification, particularly if the patient has:

  • Previously withdrawn from alcohol and experienced convulsions - but the patient is unable to take diazepines
  • Is at a high risk of experiencing convulsions - determined by doctors
  • A co-occurring condition that causes convulsions, i.e. epilepsy or encephalitis

While pregabalin can be used to treat alcohol withdrawal symptoms, this is not generally advisable for:

  • Those who have had multiple previous relapses - liver injury may occur if pregabalin is used alongside alcohol [21]
  • Those who abuse alcohol alongside other substances - pregabalin has increased risks of respiratory depression or death when combined with pre-existing opioid use [22]

Detoxing Combined Pregabalin And Alcohol Addiction

The detoxification protocol for concurrent pregabalin and alcohol addiction differs from protocols of detoxification from alcohol alone in that:

  • Pregabalin has a legitimate medical use (chronic pain or injury)
  • Monitoring for co-occurring side effects (anxiety, depression, nausea, vomiting, etc.) that can be more severe when withdrawing from both substances. Here at Abbeycare, our monitoring times for co-occurring substance detox are up to every 15 minutes
  • Replacing pregabalin with another anticonvulsant - if the patient is addicted to pregabalin but still requires an anticonvulsant for epilepsy, chronic pain, etc

Using Pregabalin & Alcohol In A Controlled Setting

Sequential Detox

If the patient suffers from polydrug and alcohol abuse, a sequential detox treatment plan may be suggested.

A sequential detox prioritises the drugs with the highest doses or the most dangerous side effects, while maintaining use of other substances such as pregabalin and alcohol [23].

Waiting For Treatment

If a patient tells their GP about combined pregabalin and alcohol use, the GP will immediately refer the patient to an appropriate facility, typically a community addiction team or alcohol addiction clinic.

If there is no treatment availability after an assessment, a consultant may advise the patient to continue Lyrica and alcohol use until there is availability to detox.

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About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Laura Morris (Clinical Lead).

Last Updated: January 16, 2024