PsychRounds: The Psychiatry Podcast Pregabalin (Lyrica)
Sep 24, 2025
Discover the intriguing world of Pregabalin, known as Lyrica, and how it stacks up against Gabapentin in psychiatric settings. The hosts delve into its unique mechanism of action and impressive absorption advantages. They explore its efficacy for generalized anxiety disorder and contrast its performance with venlafaxine. Tune in for insights on dosing, potential side effects, and concerns about misuse. With a look at its role in bipolar disorder and alcohol use, this discussion highlights essential considerations for prescribing.
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Stronger Binding Than Gabapentin
- Pregabalin binds more strongly to the alpha-2-delta-1 subunit than gabapentin, reducing excitatory neurotransmitter release.
- This shared mechanism explains similar clinical effects despite structural similarity to GABA.
Predictable Pharmacokinetics
- Pregabalin is minimally metabolized and excreted unchanged by the kidneys, lowering drug–drug interaction risk.
- It shows linear, predictable absorption across doses unlike gabapentin's nonlinear kinetics.
Dosing And Conversion Guide
- Start pregabalin at 75 mg twice daily and titrate by 75–150 mg every 3–5 days toward 300–450 mg/day.
- Use a max of 600 mg/day and note 1 mg pregabalin ≈ 5 mg gabapentin for rough conversion.