A case series examining the efficacy of gabapentin as a substitution therapy for the treatment of pregabalin use disorder

<i>Background:</i> Gabapentinoids are ligands of a brain calcium channel, which are approved for different indications, including epilepsy, neuropathic pain, or generalized anxiety disorder. Among gabapentinoids, pregabalin has been increasingly associated with a risk of pregabalin use disorder (PUD). To date, there is no recommended medical treatment for PUD. However, gabapentin, which has a lower abuse potential, could be used as a substitution therapy to reduce pregabalin withdrawal and craving. <i>Objectives:</i> To report on the experimental use of high dose of gabapentin among those with PUD. <i>Methods:</i> Case series of four patients (3 males and 1 female) with severe PUD (average daily doses ranging from 1,200 to 8,400 mg of pregabalin), in whom high dose of gabapentin was prescribed as a substitution treatment. <i>Results:</i> Upon gabapentin being administered as substitution therapy for pregabalin, all four patients experienced intense craving and distress. Despite receiving high doses of gabapentin, due to the observed levels of craving and distress, all four patients had to be rapidly switched back to pregabalin. <i>Conclusions:</i> Preliminary clinical findings suggest that gabapentin is unlikely to be a suitable, lower-risk alternative treatment for people with PUD. Additional examination of candidate medications, including other gabapentinoids, could be useful to identify an effective treatment for PUD.