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.

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

  1. Hi, diagnosed with MP 2 yrs ago. No conservative treatment worked, so I finally had decompression surgery. So far that has caused it’s own set of problems.So far did not fix it just made it “different”. Post surgery I still have spiking, burning, and my right thigh has a significant numb area, that was not there when I went in to surgery,plus it can be painful.Upper thigh feels like sunburn.
    My surgeon says give it more time to see if it can regenerate properly, because my lcfn nerve was pretty damaged compressed at the ligament.
    Took gaba for a while before surgery and it did little 2600mg a day. Now I am considering Lyrica post surgery for the residual problems with lfcn. Do you think it is worth a try? Tolerated Gaba with no problem, it just was not effective.

  2. I wish that someone had been around to give me this advice. I’ve been on a roller coaster ride with pain for the last four years.
    I saw numerous doctors, in state and out of state, with respect to my condition, and there is no diagnosis for me. By wildly searching the internet for people with symptoms like my own, the closest I could come was pudendal neuralgia.
    Doctors shrugged their shoulders and said goodbye. Having been thusly dismissed and in awful pain, I went to a pain doctor who prescribed opioids and there I have been for four years.
    This year, a gynecologist prescribed Lyrica and it was a Godsend. I had to switch to Gabapentin for insurance reasons and had the side effects you are talking about. More confusion, because doctors don’t tell about these side effects. I started at 300 x 3. Am now at 600 x 3. But, it works! The pain is very much decreased.
    The point is that it took FOUR years of “opioid pain medicine” and misery for me to get to Gabapentin. Why? Why did no doctor think of this before? You are a Family Practitioner, and yet, you understand the ins and outs of this drug. During the last four years, searching for an alternative to narcotics, I saw many doctors. My guess is that they dismissed me as a drug addict.

  3. How does lyrica compare to gabapentin in regards to regulating the sleep cycle and promoting deep sleep in people with narcolepsy? Is it similar there?

  4. I was diagnosed with idiopathic peripheral neuropathy by a neurologist in 2005. I started with electric currents shooting through my foot but that has subsided but still have terrible burning, numbness, and tingling. In May 2015, I was diagnosed with Charcot foot by an orthopedic as xrays showed my right arch had fallen and he stated the bones in my foot had broken down. I have bad swelling on the outside of the foot along with tightness. Wore a custom boot called a CROW walker for 7 months and was still swelling and having pain.

    I am not a diabetic but also have bad osteoarthritis in my feet. I was on gabapentin 75mg twice a day and because brain fog was so bad in the morning; I cut back to 1 at bedtime which helps me sleep along with my ropinirole for restless legs. I am pretty miserable in the evening hours but don’t like to take a lot of strong drugs.

    Have never felt comfortable with the Charcot foot diagnosis and wondered if maybe the swelling could be due to just the neuropathy. I am seeing a podarist now that is treating me for Charcot but wondered if maybe there might be a difference in swelling on the Lyrica. My podarist had suggested Lyrica but because it is much more expensive than Gabapentin, I decided against it. He put me in orthotic inserts which doesn’t seem to be helping either. Right now, I am about ready to try it.

    I have also tried Metnx, a new vitamin that you need a prescription for, that is suppose to work wonders for neuropathy. Took it 2 months with no results; my nerve biopsy showed I had an advanced small fiber neuropathy.

  5. Martin: Lyrica is worth a try. In just 8 days it is unlikly you got to a therapeutic dose of gabapentin. It usually takes about 1800 mg daiy to work well. Good luck. DrP.

  6. I had foot surgery on June 14th, right metatarsalgia,2 screws were placed near the 2nd metatarsal joint and a right hallux valgus interphalangeus over 6 months ago. The surgeon states that upon x-ray the surgery was a success. But, was diagnosed about 4 weeks ago with neuropathy in the toes that were operated on and have a sometimes a burning sensation that gets worse in the afternoon and evening. Took Gabapentin for 8 days without any relief. Do you think Lyrica will help with this problem? Thanks, Martin

  7. I was prescribed Nuerotin (Gabapentin) and had severe depression and limb swelling while taking it at higher dosage. My Rhuematologist told me to cut back and only to take at night. After discussing the symptoms with my GP, she took me off completely. The pain is back full force now. Would Lyrica likely have the same side effects?

  8. I don’t even know how long I been on gabapentin ! and it never worked and the Dr told me take more take more until I was taking a dangerous amount per Drs orders which i not only didn’t do I also fired my PCP and quit. I went to a pain management center where multiple Drs work dealing with football injuries or lets say pain management and surgery for problems associated with sports. football baseball soccer etc…So I say I cannot take this anymore the pain in my feet is bringing me to a bad place I cant sleep walk nothing od I need some help. She gave me samples for 2 months and my insurance has already denied the medication for me. My Dr @ the university hospital said they know how to file paperwork explaining why lyrica should be prescribed instead of gabapentin.
    4 years no good gabapentin, but one night, my first night I took the 75mg lyrica tab there was no more pain . it disappeared and that has NEVER happened before. so right now Im telling you that lyrica saved my life. I was on the verge if you know what I mean. the pain, no sleep, cant eat, cant walk or shower or anything standing up.

  9. I had a friend doctor who is an MD but is “not practicing anymore”. This MD mentioned to to me that Lyrica and Neurontin are the same drug. That there is a useless molecule added to Lyrica that falls off once it’s taken by the patient. It turns into Neurontin and has the same effect, because it’s simply an expensive form of Neurontin. I found your article interesting, but wonder about that. My mom has EM or burning foot syndrome and has had both drugs and in her case she didn’t see relief from either one, but every case can be different.

    I found the absorption rate differences you describe to be interesting. In some cases it seems some doctors will lower prescriptions of drugs because adding other drugs has a multiplication effect on the effectiveness of the other drugs that the patient is taking. But I’m only speaking in a general sense as a care giver, not a doctor or professional.

  10. Dr. Tayibelasma: I also have a patient who struggles with headache post cerebral injury. She has used these drugs without help. Not sure who to refer you to for better help. Good luck. DrP.

  11. thanks for all practical informaton Ifound here. I realy need to know
    any information about using gabapentin and lyrica to treat headache after intracerebral haemorrhage.I have here a stable patient with controlled BP and no neurological deficit . Iam waiting..thanks always.

  12. Hello Dr. I have found R,A.Dr. who did return me to Lycria. Licria does work better than gab. Lycria does not work as well as it did befor the Number one Dr. took me off and he put me on Gab.I Am happy i found a dr who who put me back on Lycria. My ? is do you think i may get better results in the future,or may never get the relief i had be for going off lycria. Thankyou. S.

  13. I have been on Gabapentin for several month, taking 900MG daily it does not seem to help a lot . It is helping a little . I recently went to another Dr. because my pain has increased. The Dr. put me on Lyrica, well I thought this would be great . The first month I felt fantastic, after that the pain started back again ,this time it was really intense . Well I took Lyrica a little while longer and finally got off of it and started Gabapentin again. I am still in so much pain I think the Doctors are just there for the money not for the patient.

  14. I have been on Lyrica for about a decade, ignoring side effects.
    My neurologist increased the dosage to 200 mg twice a day from 150.
    I started at 75 mg, twice a day.
    He had suggested I use 150 mg (left over) and the 200 mg.
    My internist had also been prescribing 150 mg (I pay only $15 a visit, the specialist charges $50,,US health care supplement).
    When I asked the internist to prescribe the 150mg, so I can alternate 150 ad 200 mg, he cut it down to 40mg.! I am ina limbo
    with pain and side effects. Any suggestions. Last year the 300 mg.
    Gabapentin gave me itching! I stopped it.
    I am getting similar problems now!
    I am old, 83 now. I am worried that doctors rush through. Can somebody help? 8:30 am, BAD NIGHT OF SLEEP.

  15. I have had sciatic nerve damage from a hip replacement surgery in 2005. The overstretched nerve caused foot drop and I have little to no major motor nerve function on my left side. My most recent EMG was in 2014 and revealed no improvement since the initial damage. I have been diagnosed with RSD and Fibromyalgia after years and trying and failing to continue to remain successful in the professional world. I am now disabled, and desperate to not let this define me as a person, but also failing.

    I was given Gabapentin early on at first occurrence of the injury. Years later, this has been an option once again, and I quickly dismissed it, remembering the ill effects of the drug, such as loss of memory, etc. My cognitive abilities are affected so much now, I really need something to help, not hinder. Lyrica was prescribed four months ago, and it was as if a switch came on. I was able to drive once more- I was able to live again, and it even assisted with the day to day problems of a spouse who doesn’t understand why they can’t fix it! Now, I feel we may be regressing backwards. I have heard some say taking Cymbalta with Gabapentin makes a difference. Any insight?

  16. Sometimes,it’s so tough to find good doctor who will give right diagnose with corresponding curing methods.

  17. I Have Lots off pain ..,I wake up at night with a pain so bad in my foot,Feels like A alagator bit me .or a knife stuck me suddenly. my dr. Took me off Lycria.sudenly. I took it for 2 years with fantastic result. I am glad to hear others havegood luck with Lycria. I was able to move around some when I was on lycria. the Dr. put me on Gab.ton.and it doe es not work as well.I would like so much to get lycria back.I have pain all over.sholders , back,hips,hands Birn and sticking pain. I worked in a factory for lots of years. tHANKS FOR the information. I have very good blood test results always.

  18. Linda: This is difficult situation for you. All I can recommend is that you come to the best choice you and your physicians can work out. Good luck. DrP.

  19. Hi, My husband’s insurance switched to Humana and they are saying that Lyrica is not FDA approved for RSD so they will not cover any of the cost. I also take Cymbalta and Celebrex (generic for both) for my condition. I have been medically controlled and am doing fine for the past 5 years. My doctor said I could try gabapintin but I have a fear of pain kicking back in. My other doctor told me not to play with fire. If I cut back or switch and the RSD pain kicks back in we may never get me back to where I am. I have started cutting my Lyrica down to 150mg once a day instead of twice to help save in the cost. I am so confused on what to do.

  20. Hi, My husband’s insurance switched to Humana and they are saying that Lyrica is not FDA approved for RSD so they will not cover any of the cost. I also take Cymbalta and Celebrex for my condition. I have been medically controlled and am doing fine for the past 5 years. My doctor said I could try gabapintin but I have a fear of pain kicking back in. My other doctor told me not to play with fire. I have started cutting my Lyrica down to 150mg once a day instead of twice to help save in the cost. I am so confused on what to do.

  21. I am so glad to find this site. I need help. I have been suffering from torticollis symptoms in my neck & I am having trouble finding any kind of relief for the pain. My doc tried a muscle relaxer at first which took the edge off somewhat. (10mg 3 times a day) My symptoms started in late July. After taking the muscle relaxer for about a month my symptoms seem to be getting worse. I have severe pain in my neck, like constant muscle spasms. Sometimes I have to wear a cervical collar or I have to literally physically hold my chin so that my head stays still. If I don’t when I look down my heed starts to shake & my chin pulls towards my right shoulder, and I have severe pain in my lower back on both sides. It’s almost impossible for me to even bend over. My doc ordered an MRI on my brain & a cervical MRI. Both came back absolutely normal. Still no diagnosis. My doc prescribed Lyrica (75mg twice a day) to see if it would help the muscle contractions & pain. After a week I am feeling very confused & groggy while taking Lyrica. I called my doc & told him the Lyrica was helping a little but I’m still in severe pain. Today he prescribed 300mg gabapentin 3 times a day. I’ve read so much about both of these drugs & I’m Mind F*****g myself. Someone please help!

  22. Jeanne: Your medical history is complicated, but it seems possible that it was stopping the Prozac from 40 mg daily abruptly that led to a SSRI discontinuation syndrome. Regarding adding the Lyrica you need to consult your physician. Good luck. Dr. P.

  23. I forgot to mention in my other post, I am also taking Modafinil 200 mg once a day. I have been taking this drug for approximately 5 years. Jeanne Mekelburg

  24. I was diagnosed with Multiple Sclurosis in l999. I have been taking Gaberpentin 300 mg first first twice a day and gradually increasing to 1200 mg twice a day, morning and night for approximately 10 years. My Dr. recently prescribed Lyrica, 150 mg morning and night due to an increase in arthritic pain and possibly an increase in MS pain, it was hard to tell the cause of the pain at times. I tolerated these dosages for approximately two months. During this same time I was also taking Bupropion 150 mg once a day along with Prozac 40 mg once a day for depression. (I had been taking Prozac for approximately 15 years and the Bupropion for 2 years). At the end of approximately two months on all these drugs, I was feeling severely depressed and my GP prescribed an increase in the Bupropion to 300 mg and took me off the Prozac. Within a few days I started experiencing a feeling of dizziness, pressure in my head and the feeling of being drugged. The Doctors, my neurologise did not seem to agree with regard to which drug was causing the problen so I went back to Bupropion 130 mg and Gabapentin 1200 mg each morning and night. I am still having a problem with extreme arthritic pain and I am wondering if it would be okay to take the Lyrica 150 mg twice a day. I don’t want to experience the problem again, but I am not sure what to do. Any help you could give would be very much appreciated. Jeanne Mekelburg

  25. I started taking lyraca and i can’t believe the instant pain relief I got.I asked my previous doctor to try it but he said what he gave me was the same. What he gave me was neurotin. I had been in severe pain for years. I have:
    fibromialgia, bursitus, bulging disks, ostioarthritus, arthritus, severe pain in my lower back. All pain inducing problems.

    In addition to lyraca my doctor also gave me tizanidine and lidocaine patches. For the first time in decades I am free of severe pain. I still have pain but I can put up with it. I am so glad I changed doctors. I looked for a woman doctor because i thought a woman would understand my situation better. Forgive my spelling. Every day I am thankful for the change I made.

  26. Dear Doctor Pullen,

    Thank you for a most informative article regarding Lyrica v Gabapentin. I have been on Gabapentin for approximately two years. My Neurologist placed me on Lyrica and it worked very well however I could not afford the medication and my insurance plan would not cover Lyrica so went back on Gabapentin. Can you advise me if Lyrica now comes in a generic medication and if so the name of the generic? I prefer it over the Gabapentin.

    Thank you for your assistance.

  27. Kathy: Lots of questions, and I’m not in a position to answer really. It is unusual to be on both Lyrica and gabapentin, but is done occasionally. The weight gain may be related to the meds in part at leasyt. The swelling could be medication related, but needs evaluation for other possible causes unless your physician feels otherwise. You should discuss these concerns with your doctor. GOod Luck. DrP.

  28. I was diagnosed with osteoarthritis several years ago and fibromyalgia in 1993. I haven’t had too many symptoms over the years until Dec 2012. I worked until my shoulder and arm could not do anything(pizza maker). I had surgery Apr 2013. I have not been able to return to work yet. I am on 2400mg of Gabapentin and 300mg Lyrica as well as 16mg Zanaflex. I recently ran out of my medications (bad, I know) but I found out how much meds really help. Is it safe to take both drugs? My dr just ordered blood work to rule out psoriatic arthritis, rheumatoid and gout. I have not healed well(if at all) after my shoulder surgery. I have terrible muscle spasms that turn into knots under the shoulder blade. I am in physical therapy and have an excellent pain mgmt dr. I don’t have diabetes, but both my parents do. My ankles swell by the end of the day, and I feel almost high when I take the lyrica. It helps the pain I’m in. My weight has gotten out of control. I eat one meal a day and have gained almost 40lbs since I have been out of work.
    Do you have any suggestions for me to bring to my dr? I am at my witts end. I want to go back to work but my body is not cooperating. Is it possible that I can go back to work in the future with the symptoms I am having?

  29. Carole: Lyrica is a consideration especially for the fibromyalgia pain. It is one of only a few medications with an FDA indication for treatment of fibromyalgia pain. It could be used in addition to her current medications if her physician agrees. If it works well she might be able to reduce some other medications. Good luck. DrP.

  30. My wife has been suffering from fibromyalgia for many years. In addition she has a bulging of L5. Her pain is in middle back when reaching,and pain at L5 when walking, or playing games like Mah Jong. She is Osteoarthritic ,and is now on. Cymbalta, Elavil, Welbuterin,Ultram, Tylonal,busperone, and Klonopin.
    We anticipate surgical intervention at L5, and she undestands the arthritic pain. However, the arthritic pain and the fibromyalgia pain have become intolerable. She cannot walk any distance. We wonder if Lyrica might help in addition to eliminating some of the other medications.

  31. Lenore: I would not expect as difficult a transition as you portray, but it may be difficult. I think you can work with your physicians to make the switch and see if you can do better. Good Luck. DrP.

  32. I was diagnosed with CRPS 2 1/2 years ago. I have been on 3600mg/day of gabapentin for the past 2 years. I have had side effects since the first pill I took but gabapentin does bring my pain down to a 4/10 when combined with nucynta..I am considering changing to Lyrica in hopes I can get rid of the side effects and be able to work once again.My main concern is the transition. My pain doctors said the pain may increase dramatically and it may take months to know if the Lyrica is working. Do you have any other suggestions?

  33. Dr. Pullen,
    Thank you for your quick reply! I am still researching whether to take the Gabapentin, or just try to get off most of my pain meds, which will leave me in so much pain!. I do not want to go through the experence with anything like, or similar to Lyrica again! I am going to ask my Pharmists to research the ingrediences and fillings for each drug There may be a connector. If you can think of other options, please let me know, wish me luck in my research! I would rather corespond by email deniseinbrevard@yahoo.com

  34. Denise: (I removed your last name as it’s not a great idea to put that much specific info on a public blog like this) I agree with your PCP re the taper off the Lyrica. Gabapentin is a reasonable option, though similar side effects are possible. You need to work closely with your physicians to figure out what is best for you. DrP.

  35. Dr. Pullen, I tried Lyria 5+- years ago and after 2 or so months totally went crazy!! I was pariniod, could not go to work for 2 weeks(could have stayed out more), felt every one was looking at me and saying crazy things that I would NEVER say!! I went to the ER (a Professor from the College I worked at took me), they had never experienced anyone with a Lyrica break-down and I do not know that they were familiar with the drug. There was no help from the ER staff-just said to stop with the Med. I got home and called my PCP and told him what had happened, I was still hystrical. He said to NOT stop the MED but to gradually taper off of it, and he gave me a plan that my Husband wrote down. Worst Experience of my life!!!

    Now, my Pain Management Doctor wants me to try Gabapentin,I am too afraid to take it considering my experience with Lyrica.

    Any other suggestions before I go back to the PAIN CLINIC???

    Thank you,
    Denise P.

    What should I do? I know you cannot dignose me on line, but what advise can you give me?

  36. Victoria: By regulation if a TV ad mentions a drug’s name they have to spend part of the commercial telling about side effects. These always sound terrible and as with all medications there are potential adverse effects. With Lyrica most people tolerate the medication OK, and if they get side effects they are usually reversible by discontinuation of the med. Hopefully you can both find some relief. DrP.

  37. Good Morning Doctor.
    This comparison article was very informative, including me understanding why the smaller amt. of GABA I & my mother-in-law have been ‘starting’ hasn’t really helped much at all. So, the tv commmercials make the side effects of LYRICA sound bad. Should we be afraid to ask our doctors to prescrbie them? My mother-in-law has been progressviely becoming more & more miserable over the last few years where the diabetic neuropathic pain is almost intolerable. Sadly, I think I’m on the same road as at 63, more diabetic neuropathic pain is worsening. Thanks in advance for your advise

  38. Dawn: I don’t usually have patients taper off neurontin and onto Lyrica, but simply switch. You should talk with your physician about this, as I cannot give patient specific recommendations here. Halucinations are not common with either med, but might be related to the combination. Again call your doctor. DrP.

  39. Thank you for the information on both meds. Just a question. I was diagnosed with trigememimal neuralgia. My doctor initially prescribed neurotin, which at one point I was taking 900 mg 3x/day, with no relief. Now she has switched me to Lyrica. So currently I am tapering off the neurotin and gradually starting the Lyrica. I am on day 2 of 4 where I am taking 75 mg 1x/day of Lyrica and 900 mg of neurotin 2x/ day. So today, I have been having some hallucinations, which were never an issue before. Could this be a symptom of withdrawing from the Neurotin or a side effect of the Lyrica. It’s a little creepy as this isn’t something I have ever dealt with.

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