Pregabalin Dosage Guide

## Overdose Profile Fatal overdose from pregabalin alone is rare. The drug has a wide therapeutic index, and case reports document survival after ingestion of doses exceeding 8,000mg with supportive care alone. However, the landscape changes dramatically when pregabalin is combined with other CNS depressants. ## Combination Overdose The combination of pregabalin with **opioids** is an increasingly recognized cause of death, particularly in the United Kingdom. Pregabalin potentiates opioid-induced respiratory depression through complementary mechanisms — while opioids directly suppress the brainstem respiratory center, pregabalin's reduction of excitatory neurotransmitter release further diminishes the drive to breathe. By 2023, pregabalin was implicated in approximately **600 deaths per year** in England and Wales, the overwhelming majority involving concurrent opioid and/or benzodiazepine use. ## Overdose Symptoms - Extreme drowsiness progressing to reduced consciousness - Confusion, agitation, and restlessness (paradoxically) - Blurred or double vision - Slurred speech and motor incoordination - In severe cases with co-ingestants: respiratory depression, coma ## Treatment There is **no specific antidote** for pregabalin overdose. Management is supportive: airway protection, monitoring of vital signs, and symptomatic treatment. **Hemodialysis** is effective at removing pregabalin from the blood (approximately 50% removal in 4 hours) and may be considered in severe cases or in patients with renal impairment.