Key takeaways:
Pregabalin (Lyrica) and gabapentin (Neurontin) are medications that treat certain types of seizures and nerve pain. Pregabalin has more FDA approved uses. But both medications are frequently prescribed off-label for a wide range of health conditions.
When comparing pregabalin versus gabapentin, they work in similar ways. But pregabalin works faster and is better absorbed by the body.
Common side effects of both medications include dizziness, drowsiness, and fluid buildup. Pregabalin is more likely to lead to weight gain. Both medications carry a small risk of dependence and misuse.
There are ways to save on the cost of pregabalin and gabapentin, which are both available as brand-name and generic medications. GoodRx can help you find ways to save on your prescription.
Save on related medications
Pregabalin versus gabapentin: which one is better? That’s the question many people ask when deciding between these two medications. They’re similar in a lot of ways, so comparing them can be tricky.
While gabapentin (Neurontin) and pregabalin (Lyrica) share many similarities, there are a few things that set them apart. Here, we’ll highlight seven key differences between these medications.
1. Pregabalin is FDA approved for more uses than gabapentin, but both are often used off-label
Pregabalin and gabapentin are both FDA approved as an add-on treatment for partial-onset seizures. But pregabalin is approved for adults and children as young as 1 month old, whereas gabapentin is approved for adults and children who are at least 3 years old.
Pregabalin and gabapentin are both also approved for nerve pain from shingles (postherpetic neuralgia).
Pregabalin has a few more approved uses than gabapentin, such as:
Nerve pain from diabetes (diabetic neuropathy)
Nerve pain from spinal cord injuries
Off-label uses
Even though gabapentin isn’t approved for these reasons, it’s still used for conditions such as fibromyalgia and diabetic neuropathy. These are examples of off-label uses of the medication. In fact, gabapentin is often a first-choice medication for diabetic neuropathy, even though it isn’t FDA approved for this condition.
Other common off-label uses of pregabalin or gabapentin include conditions such as:
Other types of nerve pain
Menopause-related symptoms
Muscle and bone-related pain, such as back pain
Headache
Sciatica treatments: Learn about the different medications that can help manage sciatic nerve pain.
Neuropathy 101: Dive into the causes and symptoms of neuropathy (nerve pain) as well as common treatment options.
How does gabapentin work? Here’s a behind-the-scenes look at how gabapentin (Neurontin) works in the body.
2. Pregabalin and gabapentin work in similar ways, but pregabalin is absorbed more quickly and fully
Pregabalin and gabapentin are known as gabapentinoids. They’re structurally similar to a chemical called GABA. GABA is an important “inhibitory” neurotransmitter (chemical messenger) in the body. This means it decreases the activation of your nerve cells, and has a calming effect.
How these medications work to treat conditions like nerve pain and seizures isn’t fully understood. Even though pregabalin and gabapentin are structurally similar to GABA, they don’t have any effect on GABA receptors (binding sites). And they don’t increase levels of GABA in the body. Instead, they likely work by decreasing the release of “excitatory” neurotransmitters in the body. Excitatory neurotransmitters activate your nerve cells. Decreasing this activation may help treat conditions such as seizures and nerve pain.
Pregabalin and gabapentin stay in your blood for about the same amount of time after you take them. But pregabalin is more quickly absorbed by the body than gabapentin. It reaches peak blood levels within about 1 hour, compared to 3 hours or more for gabapentin. So pregabalin may start working faster than gabapentin.
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Each pregabalin dose is also more fully and predictably absorbed than gabapentin. This means that as your pregabalin dose increases, you’ll have higher levels of pregabalin in the blood. This isn’t necessarily true with gabapentin.
3. Pregabalin and gabapentin come in different forms
Pregabalin and gabapentin both come as oral capsules, tablets, and a liquid solution.
In most cases, you’ll take pregabalin 2 to 3 times a day and gabapentin 3 times a day. If you have kidney problems, you may need a lower dose of pregabalin or gabapentin. This is because both medications are cleared from the body by the kidneys.
Extended-release (ER) formulations are available for both medications. The ER version of pregabalin is a tablet called pregabalin ER (Lyrica CR). It’s available as a brand-name and generic medication to treat postherpetic neuralgia and diabetic neuropathy.
Gabapentin has two brand-only ER formulations: Gralise and Horizant. Both are tablets approved to treat postherpetic neuralgia. Horizant is also approved for restless leg syndrome.
Pregabalin ER and Gralise are taken once daily. Horizant is taken once daily for restless leg syndrome, but may be taken twice daily for postherpetic neuralgia.
4. Pregabalin is considered a controlled substance by the federal government, but gabapentin is only controlled in some states
The federal Drug Enforcement Agency (DEA) lists pregabalin as a schedule 5 controlled substance. This means it's a controlled substance in every state. Gabapentin, however, isn’t considered a controlled substance by the DEA. It’s only considered a schedule 5 controlled substance in some states.
When a medication is listed as a controlled substance, it means it has a higher risk for dependence and misuse. There are also greater restrictions on how often you can fill your prescription and the amount you can fill at one time.
Schedule 5 medications are considered to pose the lowest risk among other controlled substances. For instance, the chance of dependence or misuse for pregabalin is much lower than with a schedule 2 medication, such as oxycodone. But the risk is higher with gabapentin or pregabalin than with non-controlled substances, such as blood pressure medications.
If you struggle with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
5. One may be more effective than the other in some situations
Pregabalin and gabapentin treat similar health conditions. But in some cases, one medication may work better than the other.
For example, health experts recommend gabapentin, but not pregabalin, as a treatment option for hot flashes or night sweats related to menopause. This is mostly due to a lack of research on pregabalin for this use.
When it comes to nerve pain, a clinical review of studies found that pregabalin seems to work faster and reduce pain better than gabapentin. It also caused fewer side effects. So your prescriber may recommend pregabalin over gabapentin for this use.
Talk to your healthcare team if you’re wondering whether pregabalin versus gabapentin is a better choice for you. They’ll consider your medical history, personal preferences, and expected out-of-pocket costs of these medications.
6. Pregabalin and gabapentin have similar side effects, but there are a few differences
Side effects are generally similar between pregabalin versus gabapentin. But there are a few differences to be aware of.
Common side effects
Drowsiness and dizziness are the most common side effects of pregabalin and gabapentin. These side effects may be less of an issue with extended-release formulations, such as Gralise and pregabalin ER.
Other possible side effects of pregabalin and gabapentin include:
Both medications can also cause weight gain. With gabapentin, weight gain is usually caused by excess fluid in the body. Pregabalin, on the other hand, seems more likely to cause weight gain that’s unrelated to fluid buildup.
Serious side effects
Though rare, pregabalin and gabapentin have more serious risks, as well. Examples include:
Suicidal thoughts or actions: Pregabalin and gabapentin can increase the risk of suicidal thoughts or actions at any point during treatment. Pregabalin may be more likely to cause suicidal thoughts than gabapentin.
Heart problems: A 2022 study found an increased risk for heart problems with both gabapentin and pregabalin. In the study, gabapentin was linked to more heart-related risks in the short-term.
Breathing problems: It’s wise to avoid taking pregabalin or gabapentin with other medications that slow down brain activity. Doing so could lead to excess sedation and slowed breathing. Examples include opioids, benzodiazepines, and antihistamines. Alcohol can also lead to this interaction.
Withdrawal: Stopping pregabalin or gabapentin suddenly can cause withdrawal symptoms, including nausea, agitation, and sweating. If you take pregabalin or gabapentin for seizures, stopping abruptly could cause seizures to return.
Severe allergic reactions: Gabapentin has been linked with a rare allergic reaction called DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome. And both medications may cause angioedema (swelling of the face, mouth, and throat) in rare instances. Get medical help right away if you have a fever or rash in the months after starting gabapentin.
If you or a loved one experience a change in behavior after starting either medication, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
7. Gabapentin is generally more affordable than pregabalin
Pregabalin and gabapentin are available as brand-name medications. But you can also find them as lower-cost generics. Gabapentin is generally more affordable than pregabalin. But GoodRx can help you navigate ways to save on both products:
Save with GoodRx. GoodRx can help you save over 90% off the average retail price of the generic versions of pregabalin and gabapentin. Generic pregabalin at certain pharmacies may be as low as $14.57 with a free GoodRx discount. Generic gabapentin’s price at certain pharmacies may be as low as $10.80 with a free GoodRx discount. But keep in mind that many pharmacies don’t accept discounts on controlled substances.
Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, you may pay as little as $4 for brand-name Lyrica using a savings card from the manufacturer. You may also be eligible to pay as little as $0 for Horizant or $20 for Gralise using a copay savings card.
Frequently asked questions
No, you shouldn’t take pregabalin and gabapentin at the same time. Since they work in a similar way, combining these medications can exaggerate side effects, such as dizziness and drowsiness. It can also raise your risk for falls, accidents, or slowed breathing.
No, increased blood sugar (glucose) levels aren’t a known side effect of pregabalin. There have been some reports of hypoglycemia (low blood sugar) when taking it. But this seems more likely for older people with a low body weight. Most people taking pregabalin shouldn’t experience any changes to their blood sugar levels.
There isn’t a set way to switch between gabapentin and pregabalin. And there also isn’t a set conversion between doses, since you absorb the two medications differently. In most cases, you’ll lower the dosage of gabapentin, then add in a low dose of pregabalin. From there, you’ll continue to lower gabapentin and increase pregabalin gradually until you reach the desired pregabalin dosage. Be sure to follow your prescriber’s instructions when switching from one medication to the other to avoid unwanted side effects.
No, you shouldn’t take pregabalin and gabapentin at the same time. Since they work in a similar way, combining these medications can exaggerate side effects, such as dizziness and drowsiness. It can also raise your risk for falls, accidents, or slowed breathing.
No, increased blood sugar (glucose) levels aren’t a known side effect of pregabalin. There have been some reports of hypoglycemia (low blood sugar) when taking it. But this seems more likely for older people with a low body weight. Most people taking pregabalin shouldn’t experience any changes to their blood sugar levels.
There isn’t a set way to switch between gabapentin and pregabalin. And there also isn’t a set conversion between doses, since you absorb the two medications differently. In most cases, you’ll lower the dosage of gabapentin, then add in a low dose of pregabalin. From there, you’ll continue to lower gabapentin and increase pregabalin gradually until you reach the desired pregabalin dosage. Be sure to follow your prescriber’s instructions when switching from one medication to the other to avoid unwanted side effects.
The bottom line
Pregabalin (Lyrica) and gabapentin (Neurontin) are similar medications that treat seizures and nerve pain caused by shingles. Pregabalin is FDA approved to treat more conditions than gabapentin. But both medications are often prescribed off-label for conditions such as anxiety, alcohol use disorder, and other types of pain.
When comparing pregabalin versus gabapentin, pregabalin works faster and is better absorbed by the body than gabapentin. But pregabalin is a controlled substance in every state, while gabapentin is only controlled in some states.
Both medications have similar side effects, such as drowsiness, dizziness, and edema (fluid retention). But pregabalin is more likely to cause weight gain. It’s best to avoid taking pregabalin and gabapentin at the same time or along with other substances that slow down the brain, such as opioids, benzodiazepines, and alcohol.
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