How to avoid weight gain on pregabalin

In this article:

• Why does pregabalin cause weight gain?
• Is it inevitable?
• How to avoid weight gain
• When to see a doctor

In this article

• Why does pregabalin cause weight gain?
• Is it inevitable?
• How to avoid weight gain
• When to see a doctor

An estimated 1.7 million people in the United States take pregabalin, which is FDA approved for the treatment of nerve pain in people with diabetic neuropathy, postherpetic neuralgia, spinal cord injuries, and fibromyalgia. Pregabalin may also be prescribed as an adjunct therapy for epilepsy.

Some people report gaining weight on pregabalin, also sold under the brand name Lyrica. Fortunately, there are several steps you can take to avoid that side effect.

Why does pregabalin cause weight gain?

Pregabalin (Lyrica) is a gabapentinoid, which is a class of drugs that reduce nerve pain by binding to alpha-2-delta subunits of what are called voltage-gated calcium channels (VGCCs) to decrease the release of several neurotransmitters to reduce pain signaling in the pain pathway.

There are a few main reasons why pregabalin could lead to weight gain. Peripheral edema, characterized by swelling in the extremities, is a known side effect of pregabalin. This occurs because when the drug binds to those VGCCs, it can lead to dilation of your small arteries, but there is no dilation in your small veins. This results in fluid leakage into your body tissues, causing the swelling.

A study found that peripheral edema is one of the most common side effects of pregabalin, with an incidence rate of 10% or higher. That fluid retention could cause the number on your scale to rise.

Another reason pregabalin could lead to weight gain is that it inhibits dopaminergic function in your brain when you eat food. This makes eating more enjoyable and actually encourages you to continue eating. Many people report an increased appetite while on pregabalin. The more calories you consume without burning, the more likely it is that you may gain weight.

Lastly, some people experience fatigue and drowsiness while taking pregabalin. Research suggests that older adults who also take strong opioids are at risk of experiencing this effect. (It should be noted that people with fibromyalgia have actually experienced a reduction in fatigue-related symptoms while on pregabalin. ) Any kind of fatigue or sleepiness could make it more challenging to exercise and burn calories, which can lead to weight gain. 

Is weight gain inevitable on pregabalin?

Some weight gain is a common side effect of pregabalin, but significant weight gain is not inevitable. In fact, an analysis of studies involving more than 43,000 people taking the drug found that more than 80% remained within 7% of their starting weight for close to a year. Only 1 in 6 people had an average weight gain of more than 7% two months or longer after starting to take the drug.

Several factors may increase the likelihood of weight gain with pregabalin. 

Dosage

“Studies indicate that the longer usage and/or higher dosages tend to increase the likelihood of weight gain,” explains Erika Gray, Pharm.D., founder and chief medical officer at ToolBox Genomics.com.

While dosage varies from patient to patient, most people starting pregabalin take an initial total daily dose of 150 milligrams. The length of time you may be on it depends on your condition and your healthcare provider’s advice.

One study found that people who were on the drug for more than 12 months for neuropathic pain gained an average of 3.6 pounds. This study also found that more weight was gained at higher doses, specifically those exceeding 300 milligrams a day. 

Renal function

People with kidney disease or infections may have elevated serum creatinine levels. Your kidneys filter serum creatinine. If they are damaged or if you’re dehydrated, your kidneys aren’t able to perform this function. A study found that people with higher serum creatinine levels were more likely to gain weight while on pregabalin.

Pre-existing medical conditions

Certain health conditions could exacerbate pregabalin’s side effects, including weight gain. These conditions include severe swelling, obesity, bleeding disorders, depression, respiratory issues, congestive heart failure, heart disease, diabetes, and substance abuse. It’s imperative to alert your provider to any conditions you may have.

Concurrent medications

Combining certain medications or even supplements with pregabalin could lead to weight gain. For example, in a study of veterans taking either or both duloxetine and pregabalin, those taking a combination experienced the most amount of weight gain.

There are other drugs commonly taken alongside pregabalin that may cause weight gain on their own. These include antidiabetic drugs like rosiglitazone and pioglitazone; anticonvulsants or antiepileptics like gabapentin and carbamazepine; antipsychotics; antidepressants; and corticosteroids.

Genetic predispositions

Your own genetics could play a role in how your body uses and metabolizes pregabalin. If you have a genetic predisposition that adversely affects your ability to break down the drug, you could end up with elevated levels of it in your body. Those elevated levels could then lead to weight gain.  

Lifestyle factors

Your everyday lifestyle could affect weight gain while on pregabalin. For example, if you don’t maintain a healthy diet or exercise prior to starting the drug, you may be less likely to do so based on pregabalin side effects like fatigue. 

6 ways to avoid weight gain on pregabalin

Follow these steps to sidestep potential weight gain while taking pregabalin:

1. Maintain a healthy diet

Your diet—what you consume—is a cornerstone of weight management. 

“Pregabalin can increase appetite and trigger cravings, but it’s important to manage these changes without increasing portion sizes,” says David Borrone, RPh, Oral Oncology Specialty Pharmacist at the AtlantiCare Cancer Care Institute.

Borrone has spent more than 35 years in a retail pharmacy setting and is well-acquainted with the side effects of pregabalin. He suggests several steps to keep a healthy, balanced diet:

• Choose lean meats, such as poultry and fish, over pork and red meats.
• Eat plenty of fruits and vegetables to load up on micronutrients that help you feel full and satisfied.
• Opt for whole grains and high-fiber carbohydrates, such as brown rice and whole-wheat bread, instead of white bread and pasta.
• Limit your portion size on high-calorie foods.
• Minimize snacks, especially those high in sugar and unhealthy fats.

If you’re unsure where to start, consider working with a registered dietitian who can tailor a meal plan to your specific needs.

2. Exercise

Physical activity plays a crucial role in maintaining a healthy weight because it helps burn calories. The Centers for Disease Control and Prevention suggests you do about 150 minutes of moderate-intensity aerobic activity or 75 minutes of intense aerobic activity and two days of strength training per week. A plan for regular exercise could look like:

• Five brisk walks a week, followed by strength training two days a week
• Three one-hour aerobics classes and two strength classes
• Two intense 30-minute runs each week and two days a week dedicated to weights3. Hydrate

Drinking water is associated with weight loss and long-term weight management, and consuming water before meals may also help reduce hunger. This is particularly important for individuals taking pregabalin who may experience increased hunger. 

If you were assigned male at birth, you should drink approximately 15.5 cups of water per day; if you were assigned female at birth, the recommended amount is about 11.5 cups a day.

3. Improve sleep quality 

Sleep and weight have a reciprocal relationship; that is, they can influence each other. If you aren’t at a healthy weight, your sleep may suffer; if your sleep suffers, you may be more prone to gaining weight. In fact, one study found that people who sleep less are more likely to snack, and those who get good sleep have more success with weight loss.

Experts recommend that adults get between seven to nine hours of sleep at night. Making your room dark and cool, eliminating screens before bedtime, and avoiding caffeine after noon may improve your sleep.

4. Minimize or eliminate alcohol 

Alcohol is already contraindicated if you take pregabalin because it can increase side effects that include dizziness and fatigue. Beyond that, alcoholic drinks are what are known as “empty calories”; they provide little to no nutritional value. Do your best to avoid alcohol while taking pregabalin to avoid unnecessary caloric intake and potentially serious side effects.

5. Consult your provider 

There is no shortage of reasons you may gain weight. Hormones, genetics, lifestyle, diet—the list goes on. If weight gain is a concern of yours, consult with your healthcare provider to discuss all the factors at play and get sound medical advice.

When to see your healthcare provider

If you have concerns about any side effects you may be experiencing while on pregabalin, consult with your provider. While some weight gain is common, rapid or excessive weight gain may be a sign that something is amiss. 

“Because weight gain can point to other medical conditions, it’s important to tell your healthcare provider if your weight increases by about 5 pounds in 2-3 weeks,” says Dr. Gray.

Additionally, Dr. Gray says you should contact a healthcare professional if you have any of the following, alongside weight gain:

• Chest pain
• Coughing or shortness of breath
• Irregular heartbeat
• Swelling in the ankles or legs
• Increased fatigue

If you’re having trouble maintaining your weight, your healthcare team may recommend several steps to help you achieve your goal. They may prescribe a low dose of pregabalin or suggest certain lifestyle changes. If these do not work, you may be switched to a different medication. 

“Never stop taking pregabalin or reduce your dosage abruptly without consulting with your healthcare provider,” Borrone warns. “Doing so can cause withdrawal symptoms such as anxiety, nausea, and headaches.”