Anticonvulsant / Neuropathic Analgesic Pregnancy: Avoid — teratogenicity signal in animals; limited human data. Use only if no alternative and benefit outweighs risk.

Pregabalin (Burns — Neuropathic Pain)

Brand names: Lyrica

Adult dose

Dose: 75–150 mg twice daily; titrate to 300 mg BD if tolerated

Route: Oral

Frequency: Twice daily

Max: 600 mg/day

Used for neuropathic/post-burn pain — burning, shooting, allodynia common in burns. Also reduces opioid requirements. Start low (75 mg BD) and titrate. Controlled drug (Schedule 3 in UK since 2019).

Paediatric dose

Route:

Seek specialist opinion — not licensed in children under 12 years.

Dose adjustments

Renal

Reduce dose: eGFR 30–60: max 150 mg/day; eGFR 15–30: max 75 mg/day; eGFR <15: max 75 mg on alternate days.

Hepatic

No dose adjustment required — not hepatically metabolised.

Clinical pearls

MHRA 2019: reclassified as Schedule 3 Controlled Drug — prescription requirements apply (emergency supply allowed, repeat prescriptions permitted)
Opioid-sparing effect: pregabalin reduces opioid consumption in burns by 20–30% — reduces opioid-related side effects
Post-burns neuropathic pain is extremely common — allodynia and hyperalgesia at graft edges and donor sites respond well to pregabalin

Contraindications

Hypersensitivity to pregabalin or gabapentin

Side effects

Dizziness and somnolence (very common)
Weight gain
Peripheral oedema
Blurred vision
Cognitive impairment
Dependence (Schedule 3 CD)
Respiratory depression in overdose (especially with opioids)

Interactions

Opioids (additive respiratory depression)
CNS depressants (additive sedation)
Lorazepam (additive CNS depression)
Alcohol (additive CNS depression)

Monitoring

Pain score improvement (NRS)
Dizziness and fall risk
Peripheral oedema
Respiratory rate (with opioids)

Reference: BNFc; BNF 90; MHRA Drug Safety Update 2019 (Pregabalin Schedule 3); BBA Pain Guidelines; NICE NG193 (Chronic Pain). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs