Note: We are currently revising our e-book, Loving Life on Three Legs to include a lot of new content, especially about pain management . I want to be sure this information is available now because the book is taking us so long to finish (ugh!). Here is what will be in it, and likely a future blog post:

Pregabalin: A Gabapentin Alternative for Neuropathic Pain Caused by Amputation Surgery in Dogs and Cats

Similar to Gabapentin, this anti-epileptic medication also known as Lyrica in human medicine, is now being prescribed by some veterinarians as a better source of nerve pain relief than Gabapentin. It acts on pain receptors in exactly the same way, and has the same sedative side-effect, but is more potent and more predictable with its response.

And unlike Gabapentin, Pregabalin doesn’t require as high of a dosage (or more frequent fine-tuning) to see clinical effects. According to one Pregabalin study, it has the potential to provide better pain relief in fewer doses.

Compared to gabapentin, pregabalin shows:

- Faster absorption (which happens up to the level of colon)

- Linear pharmacokinetics (non-saturable), which means that the plasma concentration is proportional to the dose administered (which is not true for gabapentin)

- Increased receptor affinity, which leads to lower doses needed when compared to gabapentin

- Terminal half-life of 7 hours (making a twice a day administration possible)

Another study evaluated the use of pregabalin (5mg/kg BID) in dogs suffering from Chiari-like malformation and showed increased tolerance in thermal and mechanical hyperalgesia and allodynia tests together with an improvement in owner-recorded pain scores (Sanchis-Mora et al., 2019). -- Gabapentin and Pregabalin as Analgesics, North Downs Specialist Referrals, Bletchingley, United Kingdom

So if Gabapentin is not working for your Tripawd, Pregabalin is worth discussing with your veterinarian. Your pet can start taking it right away, because it doesn’t require a “washout” period to switch from one to the other.

However, you may receive some pushback if you ask for it. The reason is that Pregabalin is more costly than Gabapentin. It also classified as a controlled substance, so some veterinarians may not be enthusiastic about prescribing it.

This is where advocating for your dog or cat is more important than ever to give the pain relief they deserve.

Good resources you may want to discuss include:

Pregabalin for the treatment of syringomyelia-associated neuropathic pain in dogs: A randomised, placebo-controlled, double-masked clinical trial

and

Effects of Pregabalin on Dogs, Clinician's Brief