Background
The original use of this medication was for treating seizures in humans, but not long after its introduction it was found to have use in treating neuropathic pain (the burning and tingling sensations that come from damaged nerves). There are some reports that it can also treat mild anxiety in humans and that it can have a mild anti-nausea effect as well.
As with many human drugs, this one has found its way into veterinary medicine where it is not particularly good as an anti-seizure drug but is a very effective way of treating chronic or neuropathic pain, including some cases of arthritis pain. It comes as either a tablet or a strawberry-flavoured liquid.
How This Medication is Used
For pain control, pregabalin is typically started at once daily dosing to allow your cat to adjust but can then be increased to two times daily for full effect. It may be used on its own or in conjunction with other pain relievers that may later be tapered away.
Unfortunately, it is not uncommon to develop tolerance to pregabalin so that the pain relief dose may need be increased as time goes on. How long a dose is adequate before it must be increased is highly individual.
Side Effects
Sedation and weak or wobbly hind legs are the chief side effects of concern although these are usually temporary and resolve in a few days after the cat’s body gets used to the medication. As a result, we often recommend you start this medication in the evening so the impact of this side effect is minimized. Other side effects have been reported in humans but not in cats; if you notice any side effects please bring this to the attention of your vet.
We sometimes take advantage of this side effect and prescribe higher than normal doses of pregabalin for sedation prior to stressful events such as veterinary visits. Patients usually become sedate, may stare into the distance and will lose coordination in their hind legs – this may appear alarming but is not harmful and the effect is only temporary, usually lasting 4-6 hours but residual sedation may remain for up to 24 hours. It is important that your cat be kept indoors and away from stairs or elevated surfaces while sedated with pregabalin.
Interactions with Other Drugs
- For chronic pain relief, pregabalin is best started in combination with other pain relievers but after a time often the other pain relievers can be discontinued and pregabalin may be effective as a sole agent. This may not be possible for conditions where the pain is progressively worse.
- Oral antacids may hinder absorption of pregabalin into the body by up to 20% so if possible, separate administration of these two medications by at least 2 hours.
- Concurrent use of the morphine-type drugs (such as buprenorphine) with pregabalin can increase the effectiveness of both drugs such that lower doses may be required.
Concerns and Cautions
- Pregabalin may be given with or without food.
- Cats require a very small dose for pain control so a compounded tablet or liquid may be prescribed rather than the human capsule.
- Pregabalin is removed from the body through the kidneys. If it is to be used in a patient with kidney insufficiency the dose may need to be modified, however sometimes we need to accept the increased risk to the kidneys in order to provide an acceptable degree of pain control. Please speak with us if your cat has kidney disease and you are concerned about using this medication.
- Pregabalin is not safe for use in pregnancy.
- Pregabalin should not be abruptly discontinued after long-term use as seizures can be precipitated. Instead, pregabalin should be gradually tapered off over a couple of weeks.
Please do not hesitate to get in touch if you have any concerns about giving your cat pregabalin.