Gabapentin vs. Lyrica: Understanding Your Treatment Options

What you will learn

• Gabapentin and Lyrica are similar medications used to treat nerve pain and epilepsy, but Lyrica has broader FDA approval and typically requires lower, less frequent doses.
• Studies show Lyrica tends to work faster and more predictably for nerve pain, especially for FDA-approved conditions like fibromyalgia and diabetic neuropathy.
• Both medications can cause similar side effects like dizziness and weight gain, require gradual dose adjustment, and should never be stopped suddenly due to withdrawal risks.
• While both medications carry abuse potential, Lyrica is classified as a Schedule V controlled substance and requires stricter monitoring than gabapentin, which is monitored differently by state.

Living with nerve pain, fibromyalgia, or epilepsy requires effective treatment options. Gabapentin (often sold under the brand name Neurontin) and pregabalin (brand name Lyrica) are two commonly prescribed medications that work in similar ways. While both belong to a class of drugs called gabapentinoids and are used to treat nerve-related conditions, they have distinct differences that can affect which one might be right for you. Understanding these differences can help you have more informed discussions with your healthcare provider about your treatment plan.

What is Gabapentin?

Gabapentin is a prescription medication that was originally developed to treat epilepsy and is now commonly prescribed for nerve pain and several other conditions.[1] The medication reduces abnormal brain activity and alters how your body processes pain signals.

The FDA has approved gabapentin for treating partial seizures in adults and children and managing nerve pain caused by shingles.[2] Healthcare providers also frequently prescribe gabapentin off-label for conditions such as:

• Diabetic neuropathy
• Fibromyalgia
• Restless legs syndrome
• Anxiety disorders
• Hot flashes
• Chronic pain

The medication comes in different forms, including oral capsules, tablets, and liquid solutions. Most people start with a low dose that’s gradually increased over time to minimize side effects while finding the most effective dosage for their condition.

What is Lyrica?

Lyrica, or pregabalin, is a prescription medication from the gabapentinoid class that calms overactive nerves in your body.[3] While similar to gabapentin, Lyrica has broader FDA approval and often requires less frequent dosing.

The FDA has approved Lyrica for:

• Fibromyalgia
• Diabetic nerve pain
• Spinal cord injury nerve pain
• Nerve pain after shingles
• Partial onset seizures in adults with epilepsy

Unlike gabapentin, Lyrica has more predictable absorption in your body, which means your doctor can more reliably estimate how much of the medication will be effective. The medication comes in capsule form and is typically taken 2-3 times daily, with dosage based on your specific condition and response to treatment.

What Are the Main Differences Between Gabapentin vs. Lyrica?

While gabapentin and Lyrica belong to the same medication family and work similarly, they have several important differences that can affect your treatment experience.

Chemical Structure and Action

Though structurally similar, Lyrica binds more effectively to nerve receptors than gabapentin.[4] This means Lyrica typically requires lower doses to achieve similar effects and has more predictable absorption by your body.

Absorption and Dosing

Lyrica and Gabapentin differ in their dosing and absorption profiles:[5]

• Lyrica:
  • Absorbs consistently regardless of dose
  • Usually taken 2-3 times daily
  • The typical starting dose is 75-150 mg per day
  • Maximum dose is 600mg per day
• Gabapentin:
  • Absorption decreases with higher doses
  • Usually taken 3-4 times daily
  • The typical starting dose is 300mg per day
  • The maximum dose can reach 3600 mg per day

How Effective Are Both Medications?

Both gabapentin and Lyrica work well for treating nerve pain and related conditions, but studies show. Both are also fast-acting drugs, with short half-lives and rapid onset and offset of action.[6] Regarding specific conditions, Lyrica has a slight edge in treating diabetic nerve pain since it’s officially approved for this use and has strong research backing it up.[7]

For fibromyalgia, Lyrica is often doctors’ first choice since it’s specifically approved for this condition, while gabapentin is more of a backup option.[8] Both medications work equally well regarding nerve pain after shingles, so the choice often comes down to costs and how often you need to take the medication.

Keep in mind that everyone responds differently to these medications. What works great for one person might not work as well for another. Things like your other medical conditions, age, overall health, and other medications can all affect how well either medication works for you.

How Do the Side Effects Compare?

Both gabapentin and Lyrica can cause similar side effects, though some people find one medication easier to tolerate than the other.[9] The most common side effects include feeling dizzy, sleepy, or unsteady on your feet. With either medication, you might also notice weight gain or mild swelling in your hands and feet.

Lyrica tends to be more potent, so you usually take lower doses to get the same effect. This can be convenient, but it also means some people experience side effects more quickly. Some people report feeling high on Lyrica, which is one reason it’s more strictly controlled than gabapentin.

Gabapentin often requires higher doses and more frequent dosing throughout the day. While this can be less convenient, some people prefer it because they can gradually adjust their dose to find the right balance between pain relief and side effects. The trade-off is that you might need to take it three or four times a day, compared to Lyrica’s typical twice-daily dosing.

Both medications need to be stopped gradually rather than all at once. If you need to stop taking either one, your doctor will help you slowly decrease the dose to avoid withdrawal symptoms like anxiety, trouble sleeping, or feeling irritable.

Gabapentin vs. Lyrica: Can They Both Be Abused?

Both of these medications carry a risk of abuse. Lyrica is classified as a Schedule V controlled substance by the Food and Drug Administration (FDA) due to its potential for abuse and dependence.[10] The drug can create relaxation and euphoria, particularly at higher doses. Some people may abuse Lyrica to enhance the effects of other substances, especially opioids, which can be extremely dangerous and affect the central nervous system.

While not federally classified as a controlled substance, many states now monitor gabapentin prescriptions due to increasing reports of misuse. Like Lyrica, some people abuse gabapentin for its calming effects or to intensify the effects of other drugs.

Both medications can lead to withdrawal symptoms if stopped abruptly, especially after long-term use or high doses. These symptoms might include anxiety, sleeplessness, and irritability. Healthcare providers always recommend gradually reducing the dose under medical supervision rather than stopping suddenly.

The risk of abuse increases in people with a history of substance misuse. Healthcare professionals typically consider this history when choosing between treatment options. They may recommend alternative medications or implement stricter monitoring for patients at higher risk of abuse.

How Can I Get Help?

If you’re concerned about gabapentin or Lyrica use, be sure to speak with your healthcare provider. They can help evaluate your situation and create a safe plan to adjust or stop your medication if needed. Your doctor might recommend gradually reducing your dose or switching to alternative treatments for your condition.

You can also consider reaching out to an addiction treatment center or rehab facility that specializes in prescription medication dependence. These facilities have experience helping people safely manage medication challenges and can provide inpatient and outpatient treatment options based on your needs.

Don’t hesitate to lean on family and friends for support. Having a strong support system can make a significant difference in your recovery journey. You can also ask loved ones to help you research treatment options or accompany you to medical appointments. Seeking help and support for medication concerns is a responsible step toward protecting your health and well-being.

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magna Cum Laude from Purdue University with a B.S. in Social Work. Read more