How to start Pregabalin??

[Anxious_100]

I'm currently on 20mg citalopram for anxiety, however GP has prescribed pregabalin for it and wants me to take 2 x 50mg a day to start with.

Did anyone else go from an SSRI to pregabalin and how did you do it? did you taper off the ssri slowly first, then start pregabalin, or do a straight swap?

Thanks

[Danath]

I used to take it alongside SSRIs as far as im aware theres no problem with that. does your doctor want you to swap or take both?

[hanshan]

2 x 50 mg per day pregabalin is a fairly low dose, so I would stay on the citalopram while you adjust to the pregabalin, then taper down the citalopram (and possibly taper up the pregabalin). Good luck!

[Anxious_100]

My GP said I won't be able to take both for some reason, she said there is a moderate interaction between the two drugs. I looked the interaction up for myself on the drug interaction checker via google and it confirmed this.

[MyNameIsTerry]

hanshan, this is the Moderate interaction warning on Drugs.com. It is the same for Mirt & Preg but isn't that used together? I thought I had seen a few of your guys on here being treated that way and perhaps it pokes a hole in the GP's decision? IF so, I would imagine it is because a GP isn't allowed to prescribe multiple meds together without specialist guidance.

Using citalopram together with pregabalin may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment.

Using mirtazapine together with pregabalin may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment.

[hanshan]

Hello Terry,

Thanks again for finding that information. Yes, I take both pregabalin and mirtazapine.

A "may increase side effects" warning is probably about as hypothetical as it gets. I suspect they don't actually have any direct evidence, but since both ADs and pregabalin can cause dizziness and/or reduced concentration in some people, there logically may be an additive effect (stress "may" and simply proceed with a degree of caution).

[Lan69]

I also take pregablin with mirt and on top of that I also take quetiapine ( quite a concoction) and I'm doing ok. Somedays I do feel a bit groggy but it doesn't stop me from doing what I want to do, I find sitting around doing nothing makes the 'stoned ' feeling worse and more noticeable

[MyNameIsTerry]

Thanks hanshan, I thought you were on that combo.

I can't find switching info for Preg, it's too new for the online protocols I guess. I wanted to post that because we have people on here like yourself who can give better info about such a combination and why switching with a cross-taper may still be an option since thats a very woolly interaction warning.

To put it into some context we could look at switching from Citalopram from Mirtazapine. These are a "cautious cross-taper" yet they carry the following Major interaction warning:

Interactions between your selected drugs

Major
mirtazapine citalopram
Applies to: mirtazapine, citalopram

Using mirtazapine together with citalopram can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death.

A GP would be expected to manage that warning. So, for a GP to be worried about Citalopram to Preg, seems far less of a concern. Maybe the lack of switching information is playing a part?

[nedmcg]

I take 40mg of citalopram and 300mg of pregablin (450mg at one point), i had to have a ECG before i was allowed on pregablin (due to citlopram has been known to cause long qt heart intervals and is one reason they dont offer 60mg anymore)

[hanshan]

All ADs which increase serotonin concentrations should be cross-tapered to prevent the possibility of serotonin syndrome occurring (which is self-limiting once detected and medications stopped). This is not a hypothetical about dizziness or concentration but a potentially serious reaction. To my knowledge, pregabalin does not affect serotonin levels.

Many ADs can also potentially affect heart rhythm (QT interval), although I suspect most doctors ignore this. (I believe mirtazapine is an exception to this, and is an option for people with arrhythmia.)