What happens when you take alcohol with pregabalin?
Pregabalin, sold as Lyrica and Lyrica CR, is approved for neuropathic pain (diabetic neuropathy, postherpetic neuralgia, spinal cord injury pain), fibromyalgia, and partial-onset seizures, and is widely used off-label for generalized anxiety disorder and chronic pain. Alcohol is a central nervous system depressant. Combining the two produces additive sedation, dizziness, impaired coordination, and — at the most serious end — respiratory depression.
In December 2019, the FDA issued a Drug Safety Communication warning that pregabalin (along with gabapentin) can cause serious, life-threatening, or fatal respiratory depression when combined with CNS depressants. The FDA specifically cited alcohol, opioids, benzodiazepines, antihistamines, and older adults or patients with reduced lung function. Lyrica's FDA-approved labeling was updated to reflect this risk. The UK's MHRA issued a parallel warning the same year.
Why is this important?
Pregabalin alone causes dizziness in approximately 30% of patients in clinical trials and somnolence in about 23%. Adding alcohol amplifies both, and the additive sedation can be much greater than either drug alone. Pregabalin is also frequently combined with opioids for chronic pain — and pregabalin plus opioids plus alcohol is a particularly dangerous mix that has been associated with overdose deaths.
The patients at highest risk for respiratory depression from this combination are:
- Older adults (over 65), whose respiratory reserve is reduced and who often take multiple sedating medications
- People with chronic lung disease (COPD, severe asthma, restrictive lung disease)
- People with treated or untreated sleep apnea
- Patients on opioids, benzodiazepines, muscle relaxants, sedating antihistamines, or sleep aids
- Patients with reduced kidney function (pregabalin is renally cleared; impaired clearance leads to accumulation)
- Patients with a history of substance use disorder
Pregabalin also has measurable misuse and dependence potential. It is a Schedule V controlled substance in the United States and a Class C controlled drug in the UK. People who misuse pregabalin recreationally often combine it with alcohol and opioids to enhance euphoria — and these combinations are responsible for a significant share of pregabalin-related deaths.
Beyond respiratory risk, the combination produces marked impairment: blurred vision, ataxia, slowed reaction time, falls (particularly in older adults), and significant driving impairment. Pregabalin alone is associated with weight gain and peripheral edema; alcohol does not change those risks directly but can worsen mood, sleep, and overall function in chronic pain patients.
What should you do?
Avoid alcohol while taking pregabalin. This is not optional advice for higher-risk patients — the FDA has explicitly flagged the combination as life-threatening for older adults, patients with lung disease, and patients on opioids. The risk is particularly high during dose escalation and in the first few weeks of treatment, before tolerance to sedation develops.
If you have been cleared by your prescriber to drink occasionally on a low pregabalin dose (75 to 150 mg per day) and you are otherwise healthy, the standard cautions apply: one standard drink, never daily, never combined with opioids or benzodiazepines, no driving for at least 8 hours, and have someone with you the first time you try it. Watch for warning signs: severe drowsiness, slow or shallow breathing, blue lips or fingertips, confusion, unresponsiveness. These require immediate emergency care.
If you take pregabalin together with opioids — extremely common in chronic pain — ask about naloxone as a take-home rescue medication. Naloxone reverses opioid-related respiratory depression and can buy time in a combined overdose. If you have a history of substance misuse, be especially honest with your prescriber, because pregabalin combined with alcohol is a known relapse risk.
Which specific products are affected?
The warning applies to all pregabalin products: Lyrica capsules and oral solution, Lyrica CR (controlled-release) tablets, and all generic pregabalin formulations. Doses from 75 mg up to 600 mg per day all carry the same warning. The closely related drug gabapentin (Neurontin, Gralise, Horizant) carries an essentially identical FDA warning.
Alcohol means any ethanol-containing beverage — beer, wine, hard seltzer, spirits, fortified wines, cocktails. Other CNS depressants that compound the risk include opioids (oxycodone, hydrocodone, morphine, fentanyl, tramadol, codeine, methadone), benzodiazepines (alprazolam, lorazepam, clonazepam, diazepam), Z-drugs (zolpidem, eszopiclone), muscle relaxants (cyclobenzaprine, baclofen, tizanidine), sedating antihistamines (diphenhydramine, hydroxyzine), and cannabis. Combinations of three or more depressants — for example, pregabalin plus an opioid plus alcohol — are particularly dangerous.
The bottom line
The FDA has explicitly warned that pregabalin combined with alcohol or other CNS depressants can cause fatal respiratory depression. The risk is highest in older adults, patients with lung disease or sleep apnea, and patients also taking opioids or benzodiazepines. Avoid alcohol on pregabalin, never combine multiple depressants, ask about naloxone if you also take opioids, and know the warning signs of respiratory depression so you can act quickly.