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A case of pregabalin addiction
P regabalin, a gamma‑aminobutyric acid analog, is a
new‑generation anticonvulsant that acts by reducing
the release of glutamate, noradrenaline, and substance
P. Apart from use as concomitant therapy in partial
epilepsy, it is used in the treatment of treat neuropathic
pain, fibromyalgia, and generalized anxiety disorder.
Experimental studies have claimed its usefulness in the
treatment of benzodiazepine dependence and withdrawal,
as well as preventing relapse in alcohol‑dependence
patients.[1,2] Pregabalin use in primary health care has
increased recently. In therapeutic dosage, chances of
addiction are unlikely. However, there are few reports
of addictive potential of the drug when prescribed
in higher amount.[3] A case of pregabalin addiction is
presented because of its rarity in India.
A 32‑year‑old married male, an operation theater
assistant, reported with the complaints of regular use of
tablet pregabalin for the past 7 years. Initially, the patient
was prescribed tablet gabapen 300 mg bd for chronic pain
following traumatic mandibular subluxation. After taking
the medication for 3 months, he perceived improvement
in his pain. He also felt energetic. When he stopped
taking tablet gabapen, he experienced fatiguability and
irritability. Since tablet gabapen was costly and he had
easy access to tablet pregabalin, he started consuming
pregabalin. However, he was not getting the same effect,
so he kept increasing the dosage and eventually was
consuming 20 tablet/day. At this dose, he used to feel
energetic, elated, had increased work performance, and
was appreciated by his seniors. His appetite increased
significantly. Over the course of 7 years, he experienced
diminishing effect, so he gradually increased the dosage
to 40 tablet/day. Finally, he was caught stealing drugs
and was removed from the job. To satisfy his craving,
he started taking loans and sold household articles,
and consequently, his family abandoned him. He then
tried stopping tablet pregabalin for a few days, but he
experienced low mood, irritability with decreased sleep,
and appetite, so he restarted taking the tablets. His friend
eventually brought him to the psychiatric center. Past and
family history was not significant. No history of other
substance use was reported. His physical examination
and routine investigations were within normal limits.
Electroencephalogram showed right frontocentral
abnormality. On mental status examination, he was in
contemplation stage of motivation. He was admitted
and was started on tablet oxcarbazepine 150 mg bd,
S352
LETTER TO EDITOR
tablet clonazepam 0.25 mg tds, and tablet tryptomer
10 mg along with psychotherapy. Gradually, his craving
reduced and he has maintained abstinence for 3 months
after discharge.
A systematic review of 106 studies on PubMed/
Scopus did not find credible evidence of a strong
addictive power of gabapentinoids, due to their limited
rewarding properties, few relapses, and the very few
cases with gabapentinoid‑related behavioral dependence
symptoms in patients without a history of substance
abuse/dependence. Further, there were no reports of
people seeking treatment for abuse of gabapentinoids.[4]
Our patient was strongly addicted, felt euphoric and
energetic due to the drug, gave history of relapse, and
came for treatment. It is assumed that gabapentinoid
pharmacodynamics possibly include brain’s drug‑reward
pathways.[5] Physicians prescribing gabapentins should
carefully evaluate any history of substance misuse before
starting the drug. Furthermore, they should be able
to promptly identify signs of pregabalin/gabapentin
misuse, while providing assistance in tapering off the
medication.[6] The tendency to downplay the addiction
potential of gabapentinoids should cease forthwith.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form, the legal guardian has
given his consent for images and other clinical information
to be reported in the journal. The guardian understands
that names and initials will not be published and due efforts
will be made to conceal identity, but anonymity cannot be
guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Samiksha Sahu, Saurav Kumar,
Suprakash Chaudhury, Daniel Saldanha
Department of Psychiatry, Dr DY Patil Medical College, Dr DY Patil
University, Pimpri, Pune, Maharashtra, India
Address for correspondence: Dr. Suprakash Chaudhury,
Department of Psychiatry, Dr DY Patil Medical College, Dr DY Patil
University, Pimpri, Pune, Maharashtra, India.
E‑mail: suprakashch@gmail.com
© 2021 Industrial Psychiatry Journal | Published by Wolters Kluwer - Medknow
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Letter to Editor

Received: 28 February 2021 on brain GABA and glutamate concentrations: A 7T ¹H‑MRS

Revised: 07 June 2021 study. Neuropsychopharmacology 2012;37:2764‑71.
Accepted: 19 July 2021
Published: 22 October 2021 This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non‑commercially,
REFERENCES as long as appropriate credit is given and the new creations are licensed under
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pregabalin? A systematic review. Eur Neuropsychopharmacol
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issues around misuse of antiepileptics. Expert Opin Drug Saf A case of pregabalin addiction. Ind Psychiatry J 2021;30:S352-3.
2013;12:647‑57.
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© 2021 Industrial Psychiatry Journal | Published by Wolters Kluwer - Medknow
Hariharan H, et al. The impact of gabapentin administration

Industrial Psychiatry Journal  S353 Volume 30 | Supplement Issue 1 | 2021