Pregabalin

What is this medication for?

• Adjunctive therapy of refractory seizures (3rd-line after phenobarbital/bromides); neuropathic/chronic pain
• Seizure adjunct; neuropathic pain (emerging use)

How is it given?

Give exactly as your veterinarian prescribed — never change the dose or stop on your own unless your veterinarian has told you to.

• Taper rather than stop — abrupt withdrawal can unmask seizures.

What if I miss a dose?

• Give it as soon as you remember — unless it is almost time for the next dose (then skip the missed one; never double up).
• Call your clinic if you miss more than one dose in a row.

Side effects — what should I watch for?

Effects listed as common in this handout

• Sedation, wobbliness/unsteadiness (Most common — usually transient with titration)

Worth a phone call to your veterinarian

• Weight gain, peripheral edema (Human class effects)

⚠️ Contact your veterinarian or an emergency clinic IMMEDIATELY if you notice

• Withdrawal effects (seizures, insomnia, stomach/intestinal) with abrupt stop (Human rule — taper)

Before starting (or refilling), tell your veterinarian if your pet:

• has or has had: Renal insufficiency — dose adjust (renal-only clearance); heart failure caution (human); don't stop abruptly

• is pregnant, nursing, or used for breeding
• is taking any other medications, supplements, or flea/tick products, including:
  • Other CNS depressants (gabapentinoids, opioids, sedatives)
  • No hepatic CYP interactions

Storage and handling

Room temperature. Capsules/solution. Expensive (per Plumb, 7th ed. era).

Good to know

• Pregabalin = gabapentin's stronger, more predictable sibling: same α2δ target, 3–10× potency, ~90% bioavailability (vs gabapentin's saturable absorption) — at a cost premium.
• Renal-only clearance with zero hepatic metabolism: the dose follows the kidney (reduce in CKD — common in older cats with chronic pain).
• In dogs, evidence base is thin but real: 7/9 phenobarbital/bromide-refractory dogs had ~60% seizure reduction (Dewey 2009); titrate 2→4 mg/kg over weeks.
• Taper rather than stop — abrupt withdrawal can unmask seizures.