Anticonvulsant / Neuropathic Analgesic Pregnancy: Women of childbearing potential have to use effective contraception during treatment. Animal studies have shown reproductive toxicity and pregabalin may cross the human placenta. A Nordic observational study of more than 2700 first-trimester-exposed pregnancies showed a higher prevalence of major congenital malformations than in the unexposed population (5.9% vs 4.1%), with higher point estimates for nervous system, eye, orofacial cleft, urinary and genital malformations (numbers small, estimates imprecise). Should not be used during pregnancy unless clearly necessary (benefit to the mother clearly outweighing the potential risk to the foetus). Pregabalin is excreted in human milk and the effect on newborns/infants is unknown — decide whether to discontinue breast-feeding or pregabalin.

Pregabalin (Burns — Neuropathic Pain)

Brand names: Lyrica

Pregabalin is an oral gabapentinoid used in burns care as an adjuvant for neuropathic pain and to reduce the hyperalgesic, central component of burn and graft-site pain within a multimodal regimen.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Neuropathic pain: start at 150 mg per day given as two or three divided doses. Based on individual patient response and tolerability the dose may be increased to 300 mg per day after an interval of 3 to 7 days, and if needed to a maximum of 600 mg per day after an additional 7-day interval

Route: Oral (may be taken with or without food)

Frequency: Two or three divided doses per day

Max: 600 mg per day

Source: UK SPC (eMC) for Alzain 100 mg Capsules, Hard, §4.2 (https://www.medicines.org.uk/emc/product/1761/smpc). The SPC indication is neuropathic pain generally — it has no burns-specific entry; the clinician should confirm suitability for burns-related neuropathic pain and pruritus against the local protocol. The overall dose range across indications is 150 to 600 mg per day given in either two or three divided doses. Prior to starting treatment, a discussion should be held with the patient to put in place a strategy for ending treatment, to minimise the risk of dependence, addiction and drug withdrawal syndrome; treatment should be given for the shortest possible duration. DISCONTINUATION: if pregabalin has to be discontinued this should be done gradually over a minimum of 1 week, independent of the indication. OTHER INDICATIONS (§4.2): epilepsy — start 150 mg/day in two or three divided doses, may increase to 300 mg/day after 1 week and to the 600 mg/day maximum after an additional week; generalised anxiety disorder — start 150 mg/day, increase to 300 mg/day after 1 week, to 450 mg/day after a further week and to the 600 mg/day maximum after an additional week. Hepatic impairment: no dose adjustment required. Elderly: may require a dose reduction due to decreased renal function. §4.4 warns of dizziness and somnolence (increased risk of falls in the elderly), post-marketing reports of loss of consciousness, confusion and mental impairment, hypersensitivity including angioedema, severe cutaneous adverse reactions (SJS/TEN), visual effects, cases of renal failure, and post-marketing reports of congestive heart failure mainly in elderly cardiovascular-compromised patients.

Dose adjustments

Renal

Pregabalin is eliminated primarily by renal excretion as unchanged drug and clearance is directly proportional to creatinine clearance; dose reduction must be individualised according to CLcr. SPC Table 1 (total daily dose — starting dose / maximum dose): CLcr >=60 mL/min — 150 mg/day starting, 600 mg/day maximum, BID or TID; CLcr >=30 to <60 — 75 mg/day starting, 300 mg/day maximum, BID or TID; CLcr >=15 to <30 — 25 to 50 mg/day starting, 150 mg/day maximum, once daily or BID; CLcr <15 — 25 mg/day starting, 75 mg/day maximum, once daily. Haemodialysis: pregabalin is removed effectively from plasma (50% of drug in 4 hours); adjust the daily dose based on renal function and give a supplementary single dose of 25 mg (up to 100 mg) immediately following every 4-hour haemodialysis treatment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Safety and efficacy in children below the age of 12 years and in adolescents (12-17 years) have not been established and no recommendation on a posology can be made (§4.2)

Side effects

Very common: dizziness, somnolence, headache
Common: ataxia, abnormal coordination, tremor, dysarthria, amnesia, memory impairment, disturbance in attention, paraesthesia, hypoaesthesia, sedation, balance disorder, lethargy
Common: vision blurred, diplopia; appetite increased; nasopharyngitis
Common: euphoric mood, confusion, irritability, disorientation, insomnia, libido decreased
Uncommon/rare/not known: hypersensitivity, angioedema and allergic reaction; neutropenia; syncope, loss of consciousness, stupor, myoclonus, convulsions; hallucination, agitation, depression, aggression; suicidal ideation and behaviour (rare); drug dependence (frequency not known)

Interactions

Pregabalin is predominantly excreted unchanged in the urine, undergoes negligible metabolism and does not bind plasma proteins, so it is unlikely to be involved in significant pharmacokinetic drug interactions (US label §7)
No pharmacokinetic interactions with carbamazepine, valproic acid, lamotrigine, phenytoin, phenobarbital or topiramate; important pharmacokinetic interactions would also not be expected with commonly used antiepileptic drugs (US label §7)
Oxycodone, lorazepam and ethanol — no pharmacokinetic interaction seen, but ADDITIVE effects on cognitive and gross motor functioning were observed when co-administered with pregabalin (no clinically important effects on respiration were seen) (US label §7, Pharmacodynamics)
UK SPC §4.5 was not retrieved in this bundle — verify the full interaction section

Clinical monograph

How it works

It binds the alpha-2-delta subunit of voltage-gated calcium channels, reducing excitatory neurotransmitter release and dampening central sensitisation and neuropathic pain signalling.

Prescribing in practice

Combined with opioids it potentiates sedation and respiratory depression — an MHRA-warned interaction — so titrate cautiously and monitor sedation in burns patients already on strong opioids.
It is renally cleared and requires dose reduction in renal impairment, which is common after major burns, and it should be tapered rather than stopped abruptly to avoid withdrawal.
Pregabalin is a controlled drug with recognised misuse potential, so prescribe and document accordingly and review the ongoing need as pain settles.

Monitoring

Monitor neuropathic pain scores, sedation, dizziness and renal function, and review the continued need with a plan for tapering.

Counselling the patient

This targets the burning, shooting nerve-type pain and works alongside your other painkillers.
It can make you drowsy or dizzy, especially with opioids, so report excessive sleepiness.
Do not stop it suddenly; the team will reduce it gradually.

Evidence & guidelines

Gabapentinoids are used as neuropathic-pain adjuncts; the MHRA has warned of serious respiratory depression risk when combined with opioids.

Reference: MHRA Drug Safety Update 2019 (Pregabalin Schedule 3); BBA Pain Guidelines; NICE NG193 (Chronic Pain); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs