Pregabalin (Lyrica) and gabapentin are GABA analogues, prescribed by doctors for nerve pain, generalized anxiety disorder, and epilepsy. On the illegal market they have become increasingly present since around 2015 — as polydrug boosters or heroin substitutes.
Clinically relevant risks in combination:
- Respiratory depression amplified — pregabalin itself barely lowers respiratory drive, but in combination with opioids the threshold shifts massively
- Sedation deepened — strain on the circulatory system
- Hard to gauge, because pregabalin in moderate doses subjectively shows few signs
In Scandinavia and the UK, pregabalin-related deaths have risen sharply. In Germany the data is still thinner, but addiction counseling reports increasing use, especially in the substitution context.
Practical notes:
- If you’re prescribed pregabalin: no alcohol, no opioids without consulting your doctor
- Recreational: extremely risky, especially with illegally sourced pregabalin tablets of unclear quality
- In case of respiratory depression: naloxone only works against the opioid component, the pregabalin component remains — keep monitoring breathing for a long time
We recommend avoiding this combination.