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Another study documents higher prescribing of diuretics in patients who initiate gabapentin or pregabalin. Edema is an established, but perhaps not widely known, side effect of gabapentinoids. Prior research has demonstrated that gabapentinoid initiation can lead to prescription of loop diuretics, a so-called “prescribing cascade” ( NEJM JW Lyrica is more likely than gabapentin to cause side effects such as dry mouth, constipation, swelling (edema), breast enlargement, or weight gain Gabapentin is more likely than Lyrica to cause side effects such as difficulty speaking, fever, an increased risk of viral infections, unusual eye movements, or jerky movements Medications are a common reason for swollen ankles and feet, also called pedal edema. Amlodipine (Norvasc), gabapentin (Neurontin, Horizant, Gralise), and pregabalin (Lyrica) can cause puffy legs and ankles. The association of widely used neurological agents gabapentin and pregabalin and heart failure (HF) is not widely known, although fluid retention after their use in the form of peripheral edema has been recognized. Background: Pregabalin is used in the treatment of postherpetic neuralgia, diabetic neuropathic pain, partial seizures, anxiety disorders and fibromyalgia. Recognized adverse effects associated with its use include cognitive impairment, somnolence and dizziness. In 2008, after the decompression surgery, the patient was given pregabalin (titrated to 300 mg, twice daily) for ongoing neuropathic pain. Increasing peripheral edema in the patient’s legs was documented from that time on. In 2011, chronic wounds with serous drainage developed on the patient’s legs. We hypothesize that there is an increased risk of heart failure or edema in individuals receiving pregabalin compared to placebo or gabapentin. To investigate this further, we will conduct a systematic review of pregabalin across all available studies. The authors reported bilateral pretibial edema after 3 weeks of gabapentin 300 mg/d for neuropathic pain. Within 3 days of discontinuation of gabapentin, the edema resolved. When the patient was rechallenged with gabapentin, the edema returned after 5 days, suggesting the authors' suspicions of an adverse effect from gabapentin was likely correct. If you need to go off gabapentin, do it slowly to avoid a symptom flare up due to withdrawals. Also, both drugs (gabapentin and pregabalin) are metabolized by your kidneys. If you have serious renal impairment, talk to your kidney specialist before trying either drug. Fibro Patient Resources Gabapentinoids can cause concentration-dependent peripheral edema of early onset. Reduced myogenic tone is the main mechanism of these non-cardiogenic edemas. In case of peripheral edema or heart failure, a drug etiology should be considered. This is not the case however. Gabapentin is the generic of a different medication, Neurontin. Nevertheless, the chemical structures of Lyrica and gabapentin are nearly identical to one another. The main difference between the two medications is that Lyrica is more potent, and lasts longer per dose than gabapentin. Furthermore, experimental data have shown an indirect inhibitory effect of gabapentinoids (ie, gabapentin, pregabalin) on the Cav1.2 channel pore of arterial myocytes, leading to vasodilatory effects and inhibition of the myogenic tone. 96-98 These data suggest that gabapentinoid-related peripheral edema 94, 95 may exhibit the same Gabapentinoids are ligands of the α2-δ subunit of voltage-gated calcium channels (Cav) that have been associated with a risk of peripheral edema and acute heart failure of unknown clinical and pathophysiological characteristics. DailyMed. Label: pregabalin capsule.. DailyMed. Label: gabapentin capsule.. Baldwin DS, den Boer JA, Lyndon G, Emir B, Schweizer E, Haswell H. Efficacy and safety of pregabalin in generalised anxiety disorder: a critical review of the literature. Dizziness and somnolence are the most common side effects in both drugs (>20% seen in gabapentin). 3-5 Confusion and peripheral edema have also been reported with gabapentin. 4 Edema is a well-described side effect of gabapentinoid drugs (i.e., gabapentin and pregabalin). In this study from Ontario, Canada, researchers used provincial databases to examine whether gabapentinoid use was followed by diuretic prescriptions — a so-called “prescribing cascade” in which a drug is prescribed to treat an adverse effect of another drug. In 2008, after the decompression surgery, the patient was given pregabalin (titrated to 300 mg, twice daily) for ongoing neuropathic pain. Increasing peripheral edema in the patient’s legs was documented from that time on. In 2011, chronic wounds with serous drainage developed on the patient’s legs. All cases of peripheral edema or HF involving gabapentin or pregabalin were reported to the French Pharmacovigilance Centers between January 1, 1994 and April 30, 2020 [4]. A total of 58 reports were included (gabapentin n = 5, pregabalin n = 53). The authors reported bilateral pretibial edema after 3 weeks of gabapentin 300 mg/d for neuropathic pain. Within 3 days of discontinuation of gabapentin, the edema resolved. When the patient was rechallenged with gabapentin, the edema returned after 5 days, suggesting the authors' suspicions of an adverse effect from gabapentin was likely correct. Gabapentinoids can cause concentration-dependent peripheral edema of early onset. The primary mechanism of non-cardiogenic peripheral edema is vasodilatory edema secondary to altered myogenic tone, independent of Ca<sub>v</sub>1.2 blockade under the experimental conditions tested.
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