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Pregabalin Dependence Risk — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersPregabalin Dependence RiskMRCPsych Paper B

A 35-year-old man with generalised anxiety disorder has taken pregabalin 300 mg daily as prescribed for 18 months. He asks about the risks of continuing treatment and what might happen if it is stopped. Which counselling statement is most accurate?

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Reveal the answer and explanation

Correct answer: B — Dependence can occur at therapeutic doses, with withdrawal after stopping or reducing

Pregabalin can cause physical dependence even when taken at recommended therapeutic doses. Withdrawal symptoms may occur after abrupt cessation or a significant dose reduction and include anxiety, insomnia, nausea, headache, sweating, dizziness and, rarely, convulsions. The need for ongoing treatment should be reviewed regularly; if pregabalin is stopped, the dose should be reduced gradually using an individualised schedule, which may take weeks or months. A history of substance misuse increases risk but is not required, so A is incorrect. Both tolerance and physical dependence can occur, excluding D. Withdrawal is not confined to supratherapeutic doses, excluding C. Pregabalin's Schedule 3 controlled-drug status reflects misuse and dependence risks but imposes no fixed 12-month treatment limit, excluding E.

Reference: MHRA, Improving Information Supplied with Gabapentinoids (Pregabalin/Gabapentin), Benzodiazepines and Z-Drugs, Drug Safety Update, 8 January 2026. https://www.gov.uk/drug-safety-update/improving-information-supplied-with-gabapentinoids-pregabalin-slash-gabapentin-benzodiazepines-and-z-drugs