Combining pregabalin and alcohol is dangerous because both are central nervous system (CNS) depressants. When taken together, they amplify each other’s sedating effects, significantly raising the risk of severe drowsiness, impaired breathing, and life-threatening respiratory depression. The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) explicitly advises patients to avoid alcohol during pregabalin treatment. If you or someone you care about is finding it difficult to control pregabalin or alcohol use, this page explains the risks and where to find help.
What Pregabalin Is and Why It Affects the Brain
Pregabalin, sold under the brand name Lyrica, is a prescription medicine used to treat neuropathic pain, partial seizures, generalised anxiety disorder (GAD), and fibromyalgia. It belongs to a class of medicines called gabapentinoids.
Pregabalin works by binding to the alpha2-delta (α2-δ) subunit of voltage-gated calcium channels in presynaptic nerve cells. This reduces calcium influx into the nerve terminal, which in turn decreases the release of excitatory neurotransmitters such as glutamate and substance P. In simple terms, it slows and quietens overactive nerve signalling throughout the brain and spinal cord. That is why it reduces pain and anxiety, but it is also why it carries sedation as a side effect and why it interacts dangerously with other substances that depress the nervous system.
Pregabalin is a controlled drug in the UK. Following growing evidence of misuse and dependence, the Home Office reclassified it as a Schedule 3, Class C controlled drug on 1 April 2019, on the recommendation of the Advisory Council on the Misuse of Drugs. Prescriptions are limited to 30 days’ supply at a time.
How Alcohol Affects the Central Nervous System
Alcohol is also a central nervous system depressant. It works primarily by enhancing the activity of the inhibitory neurotransmitter GABA and reducing the activity of the excitatory neurotransmitter glutamate. This combination slows communication between brain cells, producing the characteristic effects of alcohol: reduced inhibitions initially, followed by progressively impaired co-ordination, slowed reaction times, drowsiness, and at higher doses, suppressed breathing.
This is not just a feeling of relaxation. Alcohol directly reduces the brain’s drive to breathe. At lower doses this is mild. At higher doses, or when combined with another substance that also suppresses the respiratory system, it can become dangerous very quickly.
What Happens When You Mix Pregabalin and Alcohol
When two CNS depressants are taken together, their effects do not simply add up. They interact in ways that can amplify each other’s impact beyond what either substance would produce alone.
Both pregabalin and alcohol slow the central nervous system, and combining them increases the depth of sedation, the degree of respiratory suppression, and the likelihood of a serious adverse event. The table below summarises what each substance does alone and what the combination produces.
| Effect | Pregabalin alone | Alcohol alone | Combined |
|---|---|---|---|
| Sedation / drowsiness | Moderate to significant | Moderate to significant (dose-dependent) | Markedly amplified |
| Motor co-ordination | Impaired | Impaired | Severely impaired |
| Reaction time | Slowed | Slowed | Severely slowed |
| Respiratory rate | Can reduce (risk at high doses) | Can reduce (risk at higher doses) | Significantly increased risk of dangerous suppression |
| Memory / cognition | Impaired | Impaired | Severely impaired |
| Risk of overdose | Present | Present | Substantially higher |
The official product information for pregabalin states that alcohol may potentiate the impairment of motor skills and sedating effects of pregabalin. This means that even if both substances are within their typical ranges individually, the interaction can produce effects that feel like a much larger dose of either.
People who take pregabalin as prescribed and drink even small amounts of alcohol may find the combination far more impairing than they expected. People who misuse pregabalin at high recreational doses and combine it with alcohol face a substantially higher risk of losing consciousness, stopping breathing, or dying.
The Respiratory Depression Risk
The most serious consequence of combining pregabalin and alcohol is respiratory depression, a slowing and shallowing of breathing that, in severe cases, can lead to coma and death.
Between January 2014 and December 2020, the MHRA received 122 Yellow Card reports of respiratory depression or dyspnoea associated with pregabalin. In 80 of those 122 cases, other CNS depressants — including opioids, benzodiazepines, or gabapentin — had also been taken. The MHRA noted that a proportion of cases occurred in the absence of other CNS depressants, meaning pregabalin alone can cause serious breathing problems in vulnerable individuals.
Following a broader European review, the European Medicines Agency (EMA) issued a safety alert in October 2021 confirming postmarketing reports of respiratory failure, coma, and deaths in patients taking pregabalin alongside opioids and other CNS depressants.
The groups most at risk include:
- People aged over 65
- People with existing respiratory disease (such as COPD or asthma)
- People with neurological disease
- People with renal impairment (which affects how pregabalin is cleared from the body)
- People taking pregabalin at high doses alongside other CNS depressants
A 2022 study published in the British Journal of Clinical Pharmacology analysed 3,051 gabapentinoid-related deaths in England between 2004 and 2020. Pregabalin was detected in 2,322 of those cases (76.1%). Alcohol was co-detected in 24.5% of all cases. The study found that deaths involving gabapentinoids — predominantly pregabalin — rose from 8.9% of all relevant reports in 2014 to 32.3% by 2020, reflecting the growing scale of the problem.
When It Becomes Life-Threatening: Signs to Watch For
Respiratory depression from pregabalin and alcohol can escalate quickly. Knowing the warning signs may save a life.
Call emergency services immediately (999 in the UK, 000 in Australia, 112 in the EU and Thailand) if you see:
- Breathing that becomes very slow, shallow, or irregular
- Long pauses between breaths
- Skin, lips, or fingertips turning blue or grey (cyanosis)
- Severe drowsiness where the person cannot be roused normally
- Loss of consciousness
- Gurgling or choking sounds
Do not leave the person alone. If they are unconscious and breathing, place them in the recovery position (on their side) to prevent choking. Do not give them coffee, try to walk them around, or assume they will sleep it off. Breathing suppression can worsen over time even if the person seems stable.
Always seek medical advice promptly if you are worried, even if the situation seems less severe. It is far safer to seek help and not need it than to wait.
Pregabalin’s Dependence Risk
Pregabalin carries a significant risk of dependence that is not always appreciated by people prescribed it. Its reclassification to Schedule 3 in the UK was driven specifically by MHRA-documented evidence of abuse and dependence: by April 2019 the Yellow Card system had received 113 reports of pregabalin abuse and 98 reports of dependence.
Pregabalin can produce feelings of euphoria and sedation, particularly at doses above therapeutic ranges. This is why it is sought recreationally and why it is sometimes combined with alcohol or opioids to intensify those effects. The combination with opioids is especially dangerous — research has found opioids co-detected in 92.0% of gabapentinoid-related deaths in England — but alcohol also compounds the risk meaningfully.
A 2024 study from an addiction treatment centre found that patients with pregabalin dependence reported using it primarily to reduce opioid cravings (noted by the majority of participants), for sedation, and to produce euphoria. The presence of concurrent substance dependence, particularly opioid dependence, was a consistent feature.
Dependence can develop even in people who take pregabalin as prescribed. Dose escalation, tolerance, and difficulty stopping are warning signs. If you find that you are taking more pregabalin than prescribed, supplementing with alcohol to achieve the desired effect, or feeling physically unwell when you try to reduce or stop, those are signs worth taking seriously with your prescriber.
Pregabalin Withdrawal: What to Expect
Stopping pregabalin — particularly after high doses or long-term use — can produce a withdrawal syndrome. Do not stop pregabalin suddenly without speaking to your doctor first. Abrupt cessation carries the risk of seizures, which is a medical emergency.
Withdrawal symptoms that have been reported include:
- Insomnia and sleep disturbance
- Anxiety, irritability, and restlessness
- Headaches, nausea, and diarrhoea
- Sweating and tremors
- Palpitations and elevated heart rate
- Depression and low mood
- In more severe cases: paranoia and auditory hallucinations
According to published clinical research, acute pregabalin withdrawal symptoms typically begin within 24 hours of the last dose. They tend to peak over the following days and may linger for several weeks in the form of mood disturbance and sleep disruption. The severity is influenced by how long a person has been taking pregabalin, the daily dose, and individual factors.
The safest approach is a gradual, supervised reduction under medical guidance, known as tapering. Clinical protocols may involve slowly reducing the pregabalin dose over weeks, with monitoring and support. In some cases, a short-term bridge medication may be prescribed to manage withdrawal symptoms while the dose reduces. Your GP, an addiction specialist, or a medically supervised detox programme can help with this.
Who Is Most at Risk
While anyone taking pregabalin alongside alcohol is at some degree of elevated risk, certain groups face substantially greater danger.
| Risk factor | Why it matters |
|---|---|
| Older adults (65+) | Slower drug metabolism, higher sensitivity to sedation and respiratory effects |
| Respiratory disease (COPD, asthma, sleep apnoea) | Already compromised breathing capacity; less reserve to compensate for suppression |
| Renal impairment | Pregabalin is cleared entirely by the kidneys; reduced clearance leads to higher drug levels |
| Concurrent opioid use | The most dangerous combination; opioids + pregabalin have been linked to a substantial proportion of gabapentinoid-related deaths |
| History of substance use disorder | Higher likelihood of dose escalation and poly-drug use |
| Taking pregabalin at high doses | Studies show high-dose pregabalin use (over 300 mg per day) alongside opioids is particularly associated with an increased risk of death |
| Using alcohol regularly alongside pregabalin | Cumulative CNS suppression effect; risk increases even if individual doses seem modest |
If you fall into more than one of these categories, the risk compounds. Speak to your prescriber about your alcohol use and any concerns about your pregabalin prescription. This is a conversation that can and should happen without judgement.
Seeking Help for Pregabalin or Alcohol Problems
If you are finding it difficult to control your use of pregabalin, alcohol, or both, support is available and the situation is not hopeless.
In the UK, the first step is usually your GP, who can review your prescription, initiate a supervised taper if appropriate, and refer you to local NHS drug and alcohol services. Frank (talktofrank.com) also provides non-judgemental information and a helpline.
For people whose use has become entrenched, or who have tried to cut down without success, medically supervised detox within a structured residential programme can provide a safer and more supported route to stopping.
The Orchid Recovery is a boutique residential addiction treatment centre in the Hang Dong District of Chiang Mai, Thailand, providing personalised programmes for a maximum of 20 international clients at any one time. Our Lyrica and pregabalin addiction treatment programme is designed for adults struggling with pregabalin dependence, including those who are also using alcohol or other substances. Psychiatric oversight is provided full-time on site by Dr. Suttipan Takkapaijit (MD, Thai medical license 13333), and our team is experienced in managing medically complex presentations safely.
Prescription drug addiction treatment at The Orchid encompasses medically supervised detox, individual and group therapy, and two months of complimentary aftercare. Our residential programme runs at four, eight, or twelve weeks. Treatment begins from USD $7,900, which is typically well below the cost of comparable private residential care in the UK or Australia.
If alcohol dependence is the primary concern, our alcohol addiction treatment programme and alcohol detox pathway are available within the same residential structure.
Concerned about pregabalin or alcohol use? We can help you understand your options Our small admissions team at The Orchid Recovery in Chiang Mai speaks with international clients every week. We can walk you through what medically supervised treatment involves, what to expect, and answer any questions — with no pressure to commit to anything. Speak to our admissions team: /contact-us/
Sources
- MHRA. “Pregabalin (Lyrica): reports of severe respiratory depression.” Drug Safety Update, February 2021. https://www.gov.uk/drug-safety-update/pregabalin-lyrica-reports-of-severe-respiratory-depression
- MHRA. “Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April.” Drug Safety Update, April 2019. https://www.gov.uk/drug-safety-update/pregabalin-lyrica-gabapentin-neurontin-and-risk-of-abuse-and-dependence-new-scheduling-requirements-from-1-april
- Kalk et al. “Fatalities associated with gabapentinoids in England (2004–2020).” British Journal of Clinical Pharmacology, 2022. PMC9543893. https://pmc.ncbi.nlm.nih.gov/articles/PMC9543893/
- Gahr et al. “Pregabalin abuse and dependence during insomnia and protocol for short-term withdrawal management with diazepam: examples from case reports.” PMC8764940, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC8764940/
- Balhara et al. “Understanding pregabalin misuse and dependence: Insights from a North Indian addiction treatment center.” PMC11469571, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11469571/
- EMA / PRAC. “Risk of Respiratory Depression with Pregabalin: PRAC Drug Safety Alert.” October 2021. https://publicsafetyandvigilance.com/2021/10/risk-of-respiratory-depression-with-pregabalin-drug-safety-alert-from-europe-medicines-agency/
Frequently Asked Questions
Is it safe to drink alcohol while taking pregabalin?
No. The MHRA and the official prescribing information for pregabalin both advise avoiding alcohol entirely during treatment. Both substances are CNS depressants, and combining them amplifies sedation and significantly raises the risk of respiratory depression. Even small amounts of alcohol can produce a stronger-than-expected sedative effect when taken alongside pregabalin. If you are unsure about your current use, speak to your prescriber or pharmacist.
Can mixing pregabalin and alcohol cause death?
Yes, it can. The MHRA has received reports of severe respiratory depression, coma, and death associated with pregabalin, including cases involving other CNS depressants such as alcohol. A peer-reviewed analysis of over 3,000 gabapentinoid-related deaths in England found alcohol was co-detected in approximately one in four cases. The risk is highest at high pregabalin doses, in older adults, and in people with respiratory conditions.
What are the signs of a pregabalin and alcohol overdose?
Warning signs include extreme drowsiness or difficulty waking the person, very slow or shallow breathing, long pauses between breaths, blue or grey-tinged lips and fingertips, disorientation, and loss of consciousness. If you observe any of these signs, call emergency services immediately (999 in the UK, 000 in Australia, 112 in the EU and Thailand). Do not leave the person alone.
Can you become dependent on pregabalin?
Yes. Pregabalin dependence is well-documented and was a key reason for its reclassification as a Schedule 3 controlled drug in the UK in April 2019. Dependence can develop with both prescribed and non-prescribed use, particularly at higher doses. Warning signs include needing higher doses to achieve the same effect, difficulty reducing or stopping, and withdrawal symptoms when doses are missed. Speak to your GP if you have concerns.
What happens when you stop pregabalin suddenly?
Stopping pregabalin abruptly can cause a withdrawal syndrome that includes insomnia, anxiety, nausea, sweating, tremors, and, in more serious cases, seizures. You should never stop pregabalin suddenly without medical guidance. A gradual, supervised reduction (taper) is the recommended approach. Your GP or an addiction specialist can help you do this safely.
Does pregabalin interact with anything else I should know about?
Pregabalin interacts with all CNS depressants, not only alcohol. These include opioid pain medicines, benzodiazepines (such as diazepam or lorazepam), sleeping tablets, certain antihistamines, and gabapentin. Combining pregabalin with opioids is particularly dangerous and has been associated with a high proportion of gabapentinoid-related deaths. Always tell your prescriber about all other medicines and supplements you are taking.
Where can I get help for pregabalin dependence in the UK?
Your GP is usually the starting point. They can review your prescription, support a supervised reduction plan, and refer you to local NHS drug and alcohol services. The FRANK helpline (0300 123 6600) provides information and signposting. For people who need more intensive support, private residential treatment offers a structured, medically supervised environment. The Orchid Recovery in Chiang Mai provides specialist pregabalin and prescription drug addiction treatment for international clients, including those with co-occurring alcohol dependence.
