Pregabalin (Lyrica) tolerance

[OtisDaMan]

It is said in the Pfizer literature that Lyrica doesn't suffer from tolerance build up in patients on it for the long term. I would like to know if anyone else has felt like they are developing tolerance to Lyrica, and particularly useful would be any links to articles discussing this issue. A bit of background:

I have been on Lyrica for about 5-6 months (at 600mg/day for around 4 months) for chronic pain in the upper back - T5. Lyrica is my only prescription pain relief. It has worked quite well until recently; as some of the last remaining side effects have faded away, so too has its effectiveness. Through some experimenting with dose I have found that decreasing my dose to 300mg/day leads to a marked increase in pain, particularly in places that were free of pain *before* I had ever tried Lyrica. The pain is particularly brutal in the joints - knees, elbows, fingers - and it feels like a cross between bad arthritis and having needles stuck into the bone; most bizarre. Even after several days at the reduced dose I still copped these adverse pain effects. On the other hand, if I lift the dose to 900mg/day taken as three 300mg doses, my pain is reduced to an acceptable level - about the same level as when I originally went to 600mg/day. Lifting the dose has not caused any increase in side effects, as far as I can tell. Finally, I have discovered that individual doses of less than 300mg fail to provide relief - I have no idea why that is.

Any comments about other people's experience with regards to tolerance much appreciated.

[deezevil1]

600mg is the max daily dose for lyrica, to be taken at different intervals through out the day... I have experimented a lot with this Medication and from my exsperiance tolerance builds VERY rapidly. I also find that taking anymore than 600mg at one time is pointless and does not increase pain relife/recreational effects. I believe taking more than this amount will only help psychologically. Exposure to lyrica for a long period of time will cause dependency, especially at high doses, so the extra pain your experiencing when trying to reduce could very well be a withdrawal symptom. Lyrica is not an opiate, its apart of the GABA family of medications, more information on its effect on the brain/body can be found easily on the interweb. I have found the only way to reverse tolerance is to compliantly stop for a week or so, from exsperiance, I have taken 600mg daily with desired effects dropping rapidly each day, but if I stop and take a break for a week I can take 300mg and get the desired effects. All the best man, Deezevil x

[nabashalam]

You are not suppose to stop lyrica cold turkey. Stopping the use of pregabalin may cause withdrawal symptoms to occur. Individuals with seizure disorders who are taking this medication should avoid suddenly stopping its use due to the risk of experiencing increased seizure frequency.

Withdrawal involves an array of symptoms that kick in when you discontinue your pregabalin use abruptly. Withdrawal is going to start happening when your body and brain have become dependent on pregabalin to function normally. It is one of the main reasons why people that are addicted to the drug find it hard to quit.

[Killrabbit]

I have been taking Lyrica for over 15 years.  It helped with chronic and diabetic nerve pain.  I have gone from 500 a day down to 200 a day.  I cannot sleep at night, gained weight and have severe itching and may have suicide ideology.  If there is another drug you can take, take it.  I am going to switch

[OtisDaMan]

Hi HtS,

Thanks for posting. I just reread your post and noticed your comment about the pain in the knees, like I have. I too am fairly convinced that it is the pregabalin - I have been using walking (5 - 10km per day) as exercise for more than 10 years, and have *never* had pain quite like this before. It just seems too coincidental with my starting pregabalin.
As well as that, all joints that have had any arthritic pain at all in the past are often painful in the morning prior to my first pregabalin dose.

[HawktheSlayer]

Hi I take Lyrica along with other meds for pain reduction. I do know that the Lyrica helps but you have to remember that with almost any drug there is a limit to how much relefie it will give. I take 250mg 2x//day me and my Dr have done what you did, increase and decrease my dosage to find the MAX and mine was 250 2x/day any more than that I do not get any more releife and any less I have more pain. I have also noticed new pain mainly knee pain that I get in the mornings it feels like my knee is being ripped apart and any movement makes it worse, but if I push through the pain and start moving it alot the pain goes away, I do feel that it is the Lyrica doing this but there is no support for it. I am thinking of having my Dr switch me from Lyrica to Norotin ( i think thats the spelling ) it is from what my Dr has told me that same a Lyrica but there are different side affects. Any way I do know that you are not at a tolerance of the Lyrica but at the max effectiveness that the drug can give you. Talk to your Dr about it but I would not mention to him/her about you taking more of the drug, without his/her permission as they may see this as a problem. You can say that you forgot to take it and noticed that you had more pain and mabey that if you took more it might help more, but again DO NOT tell them that you are changing your doseage without them knowing and allowing it.


R/
Adam

[scaredmom330]

I took Lyrica for 8 months at a rather low dose 75 mgs 3 xday. I didnt build up a tolerance but couldnt take it for the side effects...my hands and feet swelled and I gained like 35 pounds.I know if the meds work.. live with the side effects but I had to have my rings forced off twice and just couldnt take it...I know the pharmacist told me it was a controlled substance so I think you would become tolerante to it...just my two cents worth...have you discussed this with your doctor? I would think it would be time to up your dose... hope you feel better soon, take care...

[tanglewood]

I agree with what everyone is saying - I have been taking Lyrica off and on for several years (began as soon as it was approved for use in the US when ever that was). Pfizer also claims there is no withdrawl from stopping Lyrica, but I have stopped it twice and both times I had what I consider to be noticeable withdrawl. The prickly skin feeling, feeling flush, etc. it's really kind of hard to describe, but definately not pleasant. So,it makes sense to me that the body might also build up a tolerance to the medication.
Otis, I hope you get things worked out and feel better.

[CareerLady]

Hi there!

OtisDaMan, I agree with your idea that folks can experience symptoms of tolerance with Lyrica. I am having almost something analogous. I am taking Lyrica for sleep problems, and after a brief honeymoon where I slept blissfully a few nights, my problems have returned. An accompany disorder - central sensitization for itching - has also been impacted. I am MORE itchy now than I had been previously. Lyrica was affecting both of them temporarily and then lost its effect. But the pinprick sensation is new, and somewhat frightening. What is interesting to me is that I don't take Lyrica for pain - I have chronic itching, coughing and sleep arousal. So my thinking is that the pinprick sensation must be due to other aspect of tolerance and not just a return of the former pain.

I have seen the literature about Lyrica and the fact that the drug company does not think there is evidence for tolerance. What I think Pfizer is avoiding is confronting the concept of neural plasticity. (Doctors on the other hand, are only beginning to be introduced to it if they are not in the field of neurology) Here's the main idea: the action of chemicals in our bodies is not static, but dynamic. This is particularly true of chemicals that act on our central nervous system. Our bodies are constantly trying to update and correctly regulate our sensory experiences and in particular the experiences of pain, coughing, sleep arousal, itching and sensitivity to cold, which are hugely important to our survival. It is not in the interest of Pfizer to examine too closely the fact that in face of neural plasticity and the forces of adaptation, all their best pharmacology can be pretty puny and may even go for naught.

Anyway, I have gotten profoundly discouraged about ************** for my nervous system woes. I am glad I have been able to read posts here at MedWatch. Thanks.

[OtisDaMan]

Thanks for that, Tuck.

I've had a look through PubMed database to see if there have been scientific studies specifically on the question of tolerance, but without joy. As far as I can tell, the main assumption/claim is that because pregabalin is not known to be metabolically active (ie, the liver and body don't metabolise it into other molecules) the patient shouldn't develop tolerance.

I am now a bit more sceptical of that claim. That same claim would imply that side-effects (ie the effects other than the main-effect of pain relief)  should stay relatively constant too - which is contradicted by the fact that side-effects do generally fade over time. My reasoning is that since most side-effects diminish over time (eg a month or so), the human body must be adapting to the pregabalin in some manner.  The scientific literature about pregabalin is largely silent on whether this can also happen with the main-effect of pain relief.

I'm pretty sure that my condition isn't worsening at the moment, although it is a possibility. Anyway, it is a sunny day here, so I'm off to walk the dog.

All the best,  OtisDaMan

[Tuckamore]

Hey Otis,

From the "RX List. The Intenet Drug Index"
"LYRICA is not known to be active at receptor sites associated with drugs of abuse. As with any CNS active drug, physicians should carefully evaluate patients for history of drug abuse and observe them for signs of LYRICA misuse or abuse (e.g., development of tolerance, dose escalation, drug-seeking behavior."

I have been doing some searching, as I said I would. I have found numerous posts on tolerance. And as you can see even some of the litature discusses tolerance. So I do beleive as with most medications, your body can build a tolerance to Lyrica. In CP sufferes I don't think it has a thing to do with misuse, abuse or drug seeking behavior. It's just our bodies building a tolerance.

I hope this information was helpful. Peace, Tuck

[Tuckamore]

Hi OtisDaMan,

It's good to "see" you again. You have been missed on this forum. I am sorry that the Lyrica appears to be less effective for you. Have you thought of the possibility that your condition may be getting worse instead of the medication not being as effective?

That said, it makes sense to me that you may become tolerant of any medication, rather it's an opiate or not. I have not looked into this but I will. If I discover information that indicates you may develop a tolerance I will re-post on your thread.

I hope you will be able to control your pain soon. Please keep us updated and let us know how you are doing. Peace, Tuck