Lyrica vs Gabapentin: A Family Doctor’s Perspective

After at first being a skeptic I am finding a significant role for Lyrica in treatment of neuropathic pain syndromes.  Lyrica first came to market in December of 2004 in the US with approval for diabetic neuropathic pain and post herpetic neuralgic pain.  I was a slow adopter of this drug. It seemed essentially a high priced alternative to Neurontin, a closely related drug that is used off label for the same indications. It appeared another case of a drug company miraculously coming up with a new and improved version of an old drug shortly before the patent on the old drug expires as I’ve previously discussed with Nexium and Lexapro. (Pfizer markets gabapentin as Neurontin and also pregabalin as Lyrica) Lyrica is pregabalin which is chemically very similar to gabapentin and works by the same mechanism.

Over time I have come to realize that Lyrica does have some distinct advantages over gabapentin. From a practical standpoint the biggest advantage of Lyrica over gabapentin is that I can prescribe a dose of Lyrica that has a chance of working for their painful condition without intolerable Lyrica side effects at the starting dose. The lowest dose of gabapentin that is typically effective for neuropathic pain is 1800 mg daily. Starting a patient at that dose will almost always lead to intolerable drowsiness and an intoxicated sensation of disequilibrium and confusion.  We have to start gabapentin with a slow taper up in dosing to avoid these intolerable side effects. A typical starting regimen would be to start on gabapentin 100 mg three times a day, or 300 mg at bedtime for a few days and then very gradually increase the dose over a couple of weeks or more to a dose of 600 mg three times daily. Most patients do not get adequate pain relief at doses much lower than 1800 mg daily of gabapentin.  Increasing the dose much faster almost guarantees the patient stopping therapy due to these side effects. Using Lyrica I can prescribe 50-75 mg twice daily from the beginning with a good chance that the starting dose will help with the pain. If it takes a higher dose the Lyrica can be increased much faster than gabapentin without causing undue sedation and drugged feeling in most patients.

Other advantages of Lyrica over gabapentin include the faster and more consistent absorption from the gut. About 90% of Lyrica is absorbed from the gut vs. 27-60% of gabapentin being absorbed. In addition the absorption of Lyrica is not dose dependent whereas the higher the dose of gabapentin the lower the absorption rate. Both Lyrica and gabapentin work via a similar mechanism biologically.

For conditions like diabetic peripheral neuropathy I find gabapentin to be a good option. These patients have a chronic condition that has usually been slowly progressive, and gradually beginning a medication with the expectation of help over a few weeks time is acceptable to most of these patients. For more acutely painful conditions like herpes zoster and trigeminal neuralgia the idea of taking up to several weeks for pain relief is much less acceptable. In these conditions Lyrica is far more attractive.

Lyrica was also the first drug with an FDA approval specifically for treating fibromyalgia. Gabapentin is also used off label (without a specific FDA indication for the condition being treated) for fibromyalgia. It is nice as a physician to have a drug with a proven benefit for fibromyalgia as it is a notoriously difficult to treat problem. I have had a couple of patients who have had dramatic improvement of their fibromyalgia on Lyrica and have not had this type of response with gabapentin. I expect that once Lyrica loses its patent and becomes competitive with gabapentin as a generic medication it will nearly replace gabapentin as the drug of choice or treatment of neuropathic pain. For reasons unknown to me gabapentin has not come down dramatically in price like nearly every other generic drug. The cash price of gabapentin 300 mg capsules at Costco is still 14.68/ 100 capsules of the generic product, making the cost of 600 mg three times daily $26.42/ month. This compares favorably though to brand name Neurontin at $391.63 for the same dose or Lyrica 75 mg twice daily of $172.95 / month. My experience has also been that it is difficult to receive authorization from third party payers for Lyrica without previously trying gabapentin, even when gabapentin does not have FDA approval for the condition being treated.

In summary I still use generic gabapentin frequently, and find it a very good drug, but I find that Lyrica sometimes works when gabapentin seems not to be effective and that Lyrica is frequently better tolerated by patients. Especially for patients with fibromyalgia Lyrica is sometimes a remarkably effective drug when not much else seems to work.

97 Responses to Lyrica vs Gabapentin: A Family Doctor’s Perspective

  1. I started Gabapentin 300mg 3 times per day about 3 wks ago. also taking effexor 300mg per day for the last 4 mths. I found a huge difference when I started taking the Gabapentin in regards to the constant aching pains in my extremities, and I could get more things done that I normaly would not be able to do. The Gabapentin however does make me feel drowsy and I do have that “drugged up” feeling. I tend to have a higher tolerance for drugs including narcotics and benzos, not sure if that is why I can tolerate Gabapentin more. I would like to try Lyrica to see if I could take it and have the beneftis from gabapentiin but not feel so drugged up. Gabapentin has made a huge difference in my life and Besides the weight gain of 9 lbs in 3 wks and drowsiness I can handle that over what I was feeling before starting it. I will talk to my Dr about Lyrica to see if it might be better for me. I hope it doesnt make me gain anymore weight though. As far as being on the antidepressant I think I dont need it, my Dr put me on it for the pain and fatigue I was having to see if it was depression because I have a history of it, but it did very litte for me, and the first time I took gabapentin I almost immedialty felt relief :)Thank you for the comparison, gives a great explanation of the two. I’m still waiting to see a neurologist been 6mths now, so will wait to see what he has to say about my symptoms and drugs. My GP is leaning toward CFS, MS or Fibromyalgia. I do have some disc narrowing and degenerative issues with my back, he called it spondylolysis.

  2. Sheryl H: Some 92 year olds could recover from a fusion, but it is a big surgery and significant recovery. You should discuss with your family doctor. DrP.

  3. I have a 92 yr old mom. No medical issues except leg pain related to stenosis. Awful mental confusion with gabapentin. Working with Lyrica now. Dr recommend laminectomy with spinal fusion. Can 92 yr old recover from that?

  4. Janet, I am not an expert on this topic, though I cannot think of a reason there is much difference related to the gastroc sleeve. Both are immediate release products. DrP.

  5. In considering both Gabapentin and Lyricia, plus Topamax (200 mg/day), for the treatment of migraine headaches and Occipital Neuralgia, I have had a gastric sleeve which is 100cc in size & empties in 15 min.. Which medication would you recommend because of the type & placement of absorption?

  6. Jen B: I cannot give specific advice on the blog, but Lyrica sounds like an option for you. See your doctor to discuss this option. DrP.

  7. Dr Pullen, I have been on Gabapentin for about a year now, and I noticed that without it there are side effects like mini black outs that last about a second or two, and Ive noticed that my eyes tend to fuzz out during the mini’s. Do you think that Lyrica would be a safer substitute because of less risk for the same drowsed out side effects? Please email me as soon as you are able.

    Thanks.

    jennifer

  8. Thanks for your information on Lyrica VS Neurontin. I was diagnose with peripheral neuropathy 5 years ago. And not taking any medication.
    I want it to sart taking Lyrica since I read that is a very good med for that condition. But my primary care doctor prescribed me Neurontin 100mg at night time for the first week then to take one in the morning and one at night.
    I had taken last night 1st time and this morning I could bearly get out of bed, also I had this weird feeling like if I wa drugged… not a good feeling at all.
    After reading your post it does makes sense. I will be taking with my doctor about changing my med to Lyrica.

    Thanks

  9. I had an alif done 6 weeks ago. My back feels great but now i have legs nerve pain in both legs, sometimes going down the front and the rest of the time going down the back and into the calf. Doc put me on neurontin and it didnt do squat so he prescribed me a tens unit and lyrica 75 mg twice a day. The tens unit kind of works. Thanks for having this blog on here…………

  10. Terri: Tough question. It is likely to be trial and error for you on this. Work with your physician to see what works. Avoid opioids if possible as they are generally not terribly effective and side effects and tolerance issues are problematic. DrP.

  11. I have FM and oestoearthritis. I am on 1200 gabapentin, tramadol, daily multivitamin, B-12 shot every two weeks, 1000 IU of vitamin D, and 6 mg of melatonin. When it rains, snows or the weather is extremely cold, I am in so much pain. It is intolerable. What do you recommended for the pain on just these days? Thanks..

  12. i had the same issues and NITA …crying and sad after increasing lyrica….dr keeps insisting that i up the dosage to 2 in the am and 2 in the pm…i cant….im back down to 1 in the am and 2 in the pm and im ok

  13. My four year old Lhasa poo pet dog was diagnosed with polyarthopathy..(immune mediated)as well as a bulging cervical disc…his neurologist at Cornell university animal hospital prescribed pregablin 15mg bid QD.since Aug.2012 dose has been lowered to once QD since Nov.2013 plus prednisone 2’5 mg
    QOD..he is doing very well..monitoring blood work now q.six months
    Also taking 10 mg.antacid QD HS cost of pregablin $32for 60 pills.lyrica has worked well for him ..
    .

  14. I’m a 53 year old female with a herniated L4-L5 disc. My doctor prescribed Lyrica for my sciatic pain. He started me on a dosage of 75 mg twice a day on Oct 17th. The dizziness was quite bad the first two days, but was tolerable by the weekend. Today, on the 23rd, I was supposed to increase my dosage to three times daily. However, about 2-1/2 hours after taking my morning dose at 8:00 am, I experienced sudden, overwhelming panic and anxiety and I started sobbing. Part of me was wondering what the heck is going on, while another part of me felt totally out of control. Three hours later, I felt like myself again. I contacted my doctor. He has decided to discontinue the Lyrica and have me start using gabapentin instead. This episode was quite unnerving. Are you aware of patients who have switched experiencing the same severe side effects?

  15. My husband gets painful acne on his back when taking neurontin. So he always discintues it for that reason. Would Lyrica cause the same problem?? Or any other suggestions?

  16. Kim: The foggy mind and fatigue are likely to resolve. Weight gain that fast is odd, but some weight gain is fairly common on lyrica and may not improve just with time, but you may be able to manage it with diet and exercise. DrP.

  17. I just started taking Lyrica and it has been a nightmare. I have suffered with Neuropathy for several years and I have finally taken the plunge. UGH. I have gained 7 pounds in 5 days, fatigue is my new friend and the foggy mind effect is horrendous. Will any of these symptoms subside ?

  18. I have been on Lyrica for almost 2 weeks, started me out with 1 pill a day and now 2. The shooting pain in my legs and arms has stopped, the achyness is still there though. Getting charlie horses it seems more now. This morning woke with kidney pain, not sure where that came from, since I am drinking more than I have in a very long time, though seems I am craving sugar more and that is something I dont normally do. Weight gain I sure dont need, I am over 300 lbs with no way to exercise at all. Hungry now, though some say that is a good thing in my case.
    I do like Lyrica though for living without those “sparklers” and turrets syndrome in my limbs is wonderful 🙂

  19. David Lee: Gabapentin withdrawal is more of a concern in seizure patients, for a person with no history of seizures I’d not expect a problem with your physicians recommendation. DrP.

  20. I have taken Gabapentin 3 X 600 mg for 6 months now for my fibro. It doesn’t seem to work and the pain is getting worse so I am ready to try Lyrica. My Dr. has told me to go straight to 2 X 100 mg Lyrica without transition. However, I have read some articles about Gabapentin withdrawal effect and got a little bit concerned. Is Lyrica so similar to Gabapentin that withdraw effect is no issue? Many people may be interested in knowing this.

  21. Lyrica is the only medication to give relief from my fibromyalgia pain and symptoms. I believe people should also have thyroid function tests carried out – when I am slightly hypothyroid, my fibro gets much worse.

  22. I was diagnosed with FM after a severe dog bite got so infected I was put in the hospital for two days. This was right after I had surgery on my hands for Carpal tunnel. I had heard of Fm but never knew the causes. I was SURE that my hand pain and arm and neck pain had to have been a side effect of the CT, my Doctor told me I had FM, I was floored in hindsight I can see the correlation. I have now been on Gabapentin for almost a year, in February of this year I was involved in a car accident ( Hit from behind while stopped at a light ) from someone going 55 + while texting, I was injured in my lower back L4-L5 , I was given ox-cotton and Gabapentin was still being used at 1800 a day, that helped, now that I have stopped the Oxcotton the pain comes back quickly and I suffer if we use the air conditioning in the heat, the cold was worse when we lived back in MD, I moved to Spain ( southern) to avoid the cold winter back home and my husband had a job opportunity to move us. I am still in pain from FM and my husband says I sleep too much. I am looking to change medications , anyone had something close that when they changed it helped?

  23. Hi Dr Pullen. It’s nice to have a doctor with an open mind as to medications and their use, and one that takes the time to inform himself thoroughly. With that in mind, I feel I should tell you my experience with long-term use of Lyrica.
    Lyrica is very similar, as you say, to Neurontin, in that its absorption, mechanism, and elimination seem to fall along the same lines. Also, they both leave the body unchanged thus not metabolized, thus saving the patient’s liver!
    Lyrica, however, is somewhat insidious in that it virtually kills REM sleep, leaving one tired in the morning. I often find myself dreaming in the daytime, because I’m so deprived of this cathartic sleep cycle. I’m taking it for a nerve pain situation, but at this point, really, I am going to switch back to the Neurontin. Its half-life is far shorter, with which I’m more comfortable, and, true, it doesn’t cause loose bowels as does its counterpart, but the Neurontin allows one to have the critical REM sleep cycle, and for this reason, I urge great caution. Present your patients with the full picture of one vs the other, so they may make a wise choice. Often, they will choose the shorter-acting Neurontin because of the sleep effect.
    I know I might have stayed with it throughout my therapy, given this lesser-known but still very important side effect.
    Thanks

  24. I have PN, non diabetic, have been on neurotin fo 4 or so years…600mg am and pm. If I take any high dose my hair falls out…I need a higher dose…I have tried lyrica and it knocks me out…but today I ask my gp if I could take it at night and neurotin at am and noonish….he said ok reluctly ….what do you think…bye I have tried cymbalta and could not deal with the side effects….
    Long term this doesnot look good….I am 57 female that loves outdoors and exercise…can’t really walk 3 miles any more…pain at night is too much….I wonder if I am causing more damage when I walk…thank you so much

  25. My husband has Vasculitis with peripheral neuropathy. He was prescribed gabapentin (Neurontin). This really affected his mood. Lyrica worked for a while but now 450 mg does not help. His pain is almost unbearable. What other options are out there?

  26. These comments are very interesting to read. Last October, my left hand was injured with a miter saw. I severely damaged the tendons and nerves in my index finger and thumb. Most of the time the pain is bearable, but any change in weather conditions, cold weather, and accidently banging my fingers on anything makes the pain much more unbearable. My doctor has tried a vast number of drugs to help with the pain. We have tried Topomax, Depakote, Amitriptyline, Gabapentin to name a few. To date, Gabapentin has had the best results although it does not completely cover the pain. In the beginning, I was taking hydrocodone/amphetamine which worked the best. After a month of taking low dosage hydro/amphetamine, my doctor started trying other non-narcotic drugs. I’m sure this was to keep me from getting addicted to it (plus we have a major problem in our state of prescription drug abuse), but I wish we could find something that was truly effective and affordable.

  27. Can someone who’s taken both describe differences in their side effects on both. So far only comments on one or the other. I asked my dr and he actually said he never heard of side effects go either. Wow does he think I’m that stupid. Not sure I want to take lyrica if same side effects happen at dose he says I need to have relief from fibro pain. At 350-400mg per day. I just spent a year getting weight off from antidepressants. Why can’t we just take pain meds and call it a day? Thx

  28. I too suffer with nerve pain. I was prescribed gabapentin. After only a few days I knew this was not the drug for me. It put me in a deep sleep and made me feel sleepy an groggy. I also ha d bad dreams. I was feeling pretty strange. My dr. Prescribed lyrica. So far from other peoples experiences it’s better with less side effects and treates pain better. I hope it works for me.

  29. Yes i agree on that is lyrica was the first drug FDA approved medicine for the treatment of neuropathic pain syndromes. And also to cure epilepsy, fibromyalgia.

  30. I was on Lyrica long term and it helped with pain and kept me moving with only occasional sluggishness. I was switched to Gabapentin for cost purposes.

    IMO, Gabapentin has intense impacts on my mood and stamina levels. I can’t prove this 100% as I’m not a medical scientist and my objectivity can only be so good in reference to myself. That said, the hostility in action and thought is off the charts for me more and more. I do have intense pain daily but I am strongly suspecting the Gabapentin is contributing to a very foul and unpredictable level of impatience I can’t account for. I do have other health conditions that make this a complex assumption somewhat, but sometimes it’s the subtle things you miss or dismiss only to realize, with hindsight, that maybe there’s a variable in some particular medication that if you remove it, will help.

    I don’t recall experiencing this kind of aggravation with Lyrica, though I’m sure neither med is perfect for everyone. I do feel more mentally “fuzzier” as well with Gabapentin. I would not recommend it to anyone who can use Lyrica instead. Pain of any kind is horrible and nerve pain is particularly insidious on quality of Life. Hopefully you have a doctor who understands this.

  31. I have herniated disk, and a lot of nerve pain because of it, it’s taken over a year to see anyone regarding this (our medical system sucks) and the dr put me on gabapentin. I took it for almost a year, still had so much pain and felt like a cloud was over my head. Switched to Lyrica and now, after almost 2 months, a lot less pain, can keep up on the house, and the black cloud over my head is gone. Was taking 5600mg of gabapentin a day, now just 450 mg of lyrica. still have some pain, but i can walk again comfortably for now until they do something about it. (in canada, will probably go to california for surgery…)

  32. I was on Gabapentin for several years for fibro and then lost my insurance, when I was put on state insurance they refused to pay for it for my fibro as it was not FDA approved. So my doc had to put me on 50mg of Lyrica 2x a day and from the beginning I was miserable. I suffer from Basilar Migraines and this medication caused me to have several in a week, I threw up, was too dizzy to get out of bed by myself, and even in between migraines my head felt like it was going to explode. My doc reduced the dose by half for a week, I was still miserable, by a lot less than half, the next week I was off it. I paid for the next month of gabapentin myself and got on a prescription assistance plan from the pharmaceutical company until she found a way to get the stated to cover it for me. I will never take Lyrica again no matter what I have to do to avoid it.

  33. I took Gabapentin 1800 mg/day for months after surgery to replace ruptured disk failed to relieve pain.
    4 weeks out of work turned into 4 months dealing with pain.

    Gabapentin had me feeling Soooo depressed. I have never felt such deep – hopeless sadness. I finally took myself off Gabapentin and got feeling better immediately.

    I stopped taking all of my other pain meds also and changed to Nucynta which helps my pain a lot w/o the tiredness that accompanies other pain meds.

    At times my pain needs a boost so my Dr. gave me Lyrica and said that it does not give the bad effects that Gabapentin commonly does.

    I have had it for a couple of months and still do not dare to take it as the depression is a gradual thing and hard to notice.

    I compared the 2 at Rxlist.com and the percent of side effects looks almost identical, hence my hesitance to take.

    I may give it a go though as the pain has been getting high again.

    FWIW I’m sure most of you know but one of the worst things for pain is to be idle and one of the best cures for the pain and mental health is to get up and get moving = blood flow to area of pain, endorphins etc.

    Have somebody you trust keep an eye on you while you take either of these as it was hard for me to pin the meds on my depression and complete exhaustion.

  34. Lorre: Weight gain is sometimes noted with either gabapentin or lyrica. Exercise is difficult with fibromyagia, but do your best and try to find a way to reduce calories. No other advice thought. DrP.

  35. What about weight gain? I would like to start on it for my Fibromyalgia and try to get off narcotics. But I really can’t afford to gain more weight. Any advice?

  36. Thanks so much for this comparison! My husband was on gabapentin for months before and after a cervical fusion for nerve pain, and it did not seem to help much, plus it affected his personality.
    His doc just put him on Lyrica today, and Googling led me here. Good to know it’s similar but different and there’s a chance it may help him. 🙂

  37. i just started lyrica today i was on gabapentin for a year it has worked for me some. but i would get busy working and for get to take it and it would let me know. i was taking 6 to 8 pills a day with lyrica i hope to get my lifi back i work 10 to 12 aday on my feet and hopfuly do it only taking 2 lyricas a day we will see oyea how much lyrica can you take i am 250lbs so it might take a higher dose for me. i take a 75mg 2 times a day what are the doses time will tell.

  38. Lyrica has not worked for me, I am in the process of getting off, it has made me think I am loosing my mind and everyone around me saw the change in me and after the first 2 months I could not feel any relief in my neuropathy I am going to go back to Gabapentin, I am going to watch the side effects of my drugs from now on, this med really got my attention

  39. Thanks for the clarification in laymans terms. I am going to try Lyrica now, neurontin has not been effective and the side effects are killing me.

  40. I am so happy to have found this comparison before I made a huge mistake. I have been ob Lyrica since I was diagnosed a year ago and it really works well….along with the trigger point injections I am feeling much better…however, its expensive even with insurance so I was told by my insurance company actually to try gabapentin instead…u believe that?? sheeeesh…no way after reading this will I do that. I will continue with Lyrica…why try to fix something that aint broke!!

  41. I took Lyrica for two months, helped greatly. Due to expense my Dr. Put me on Gabapentin. Since day one I got every side effect listed. Had to stop , pain and burning Is back. Side effects gone after two days.

  42. I started talking Lyrica 5 years ago for Fibro and it saved my life. I’m not saying I don’t have any pain now, but the volume has been turned down enough to let me enjoy life again. I still struggle with arthritis pain and endocrine issues. The only bad thing for me is the weight gain. I put on a sturdy 20 lbs that refuses to go away. I also went through early menopause at the same time I started Lyrica so that could be part of the weight gain also.

  43. I have had Piriformis syndrome (along with a number of other medical conditions) for just over a month and am having acunpuncture treatments. But I find for 4 to 5 days afterwards the pain is almost worse!! My pain doc doesn’t want to put me on Lyrica due to the unpleasant side effects and difficult problems in my personal life.

    Annabelle, can you please tell me what dose you started on and how long it took to get some pain relief.
    Thank you very much!
    Sharon

  44. like every one else i tried
    gabapentin it efected my mind and
    made mr sick i threw up every time i took it
    but with lycra i have less pail but
    i cant get the lycra because my insurance wont pay any on it

  45. Well written, I have been on both Gabapentin and Lyrica. Gabapentin affected my memory and did nothing to help with my nerve pain, I do not remember 4 months of my life while I was on Gabapentin. I do know I shut out my friends and family and was later told I was like I was some one else. I have had doctors tell me that Gabapentin and Lyrica work the same way, I would love to have one explain why Lyrica does not have the side effects that Gabapentin does. Why Gabapentin affects people more mentally, my fiance got very angry and hostile while on Gabapentin.

  46. Lyrica has been just a total miracle drug for me. I have suffered with fibromyalgia since before anyone know what fibromyalgia was. I was diagnosed with depression, hysteria, RA negative rheumatoid arthritis, and given antidepressants, aspirin, ibuprofen, and valium. Nothing helped until a neurologist finally prescribed Lyrica.
    I have to say it has changed my life. I can now walk around without wincing in pain. Don’t get me wrong, I still know I have fibromyalgia, but I can get out of the house, play with my grandkids a little, and life is so much better. I hope the cost of Lyrica is not a hindrance to doctors to prescribe this drug because I too tried gabapentin and felt so drugged that I would not have known if it did help.
    Lyrica gets an A+ from me as a treatment for fibromyalgia. Now why don’t you come up with something for the fibro fog that so many of us suffer with. Lyrica has not helped that part of the syndrome, but it sure does help with the pain.

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