In January 2020, the Medicines Management Programme in the Health Service Executive published a document on appropriate prescribing of pregabalin (common brand name Lyrica).¹ It advises that vigilance is required when prescribing pregabalin due to the risk of dependence, illegal diversion, and medical misuse. Currently pregabalin has only three licensed indications in Ireland:

> Treatment of peripheral and central neuropathic pain

> Treatment of generalised anxiety disorder

> Adjunctive therapy in patients with partial seizures with or without secondary generalisation.

This follows on from advice provided by the Irish Medical Council in September 2019 to doctors when prescribing pregabalin to follow best practice guidelines and to only prescribe when absolutely necessary.²

Because of the risk of misuse or dependence, caution is advised when prescribing pregabalin for people with a history of drug or alcohol misuse, particularly as there is a risk of fatal interactions between pregabalin and alcohol in addition to other central nervous system depressant drugs, including opioids. All patients should be monitored for signs of misuse, diversion, or dependence. Withdrawal symptoms include anxiety, convulsions, depression, diarrhoea, dizziness, flu syndrome, headache, excessive sweating, insomnia, nausea, nervousness, and pain. The suggested tapering regime is to reduce the dose gradually by a maximum of 50–100 mg.

1 Medicines Management Programme (2020) Appropriate prescribing of pregabalin. Dublin: Health Service Executive. Available online at: https://www.hse.ie/eng/about/who/cspd/ncps/medicines-management/prescribing-tips-and-tools/appropriate-prescribing-of-pregabalin-.pdf

2 Medical Council (2019) Medical Council warns doctors to reduce over-prescribing of benzodiazepines, Z-drugs and pregabalin or face potential investigation (September 2019). Dublin: Medical Council. Available online at: https://www.medicalcouncil.ie/news-and-publications/press-releases/press-release/items/medical-council-warns-doctors-to-reduce-over-prescribing-of-benzodiazepines.html