Neurontin vs Lyrica for Pain

Here is My Question:
Lyrica and Neurontin......Lyrica gave me all the side effects and more pain. As Neurontin is the same family as Lyrica, will I get the same side effects if I try Neurontin?? Or does Neurotin work different somehow?

Answer:
Gabapentin (Brand name Neurontin) and Pregabalin (Lyrica) are very similar in terms of mechanism of action, but there are major differences between the drugs:

1. Pregabalin is absorbed rapidly and completely with peak effects within one hour of taking a dose, whereas gabapentin has poor bioavailability with a less consistent relationship between dosing and clinical effect
2. Pregabalin has linear kinetics meaning as you increase the dose there is a proportional increase in the drug level available in your body, whereas gabapentin has non linear kinetics requiring increasingly higher dose to get more drug available. 

The issues of poor bioavailability and non linear kinetics are why some people respond dramatically to gabapentin at a total dose of 300 mg in a day (a very low dose) and other people require 3600 mg in a day. Because pregabalin is much more potent and bioavailable, much lower doses are required (75 to 300 mg a day) with a more consistent relationship between dose and benefits.

Side effects are similar between the two drugs when you compare groups of patient but side effects often differ in the same patient: i.e. one person may tolerate gabapentin poorly at a dose associated with limited benefits and have side effects with pregabalin at a dose that is markedly effective. The opposite can occur as well.

Lastly, studies in people with neuropathic pain show that those who do not respond to gabapentin may respond to pregabalin. This is what doctors have observed in clinical practice for years.

Most insurance companies request a trial of gabapentin before trying pregabalin because gabapentin works well in many people AND pregabalin is more expensive. Pregabalin is a also a schedule V drug that the FDA and DEA states may have some temporary (i.e. non sustaining or addictive) psychic effects that warrants an extra level of control in prescribing. For practical purposes this means doctors have to write out the prescription instead of sending it to the pharmacy electronically (which is much easier). I have not observed these psychic effects in my patients nor have they reported these effects to me during clinic visits.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego