Names and pronunciation
(pre-gab′a-lin) Lyrica, Lyrica CR
Source page 1081
Loading InternPractice…
Individual generic drug information
Extracted information for pregabalin only.
(pre-gab′a-lin) Lyrica, Lyrica CR
Source page 1081
Func. class.: Anticonvulsant
Source page 1081
Chem. class.: γ-Aminobutyric acid (GABA) analog Controlled Substance Schedule V
Source page 1081
Do not confuse: Lyrica/Lopressor
Source page 1081
ACTION: Binds to high-voltage–gated calcium channels in CNS tissues; this may lead to anticonvulsant action similar to the inhibitory neurotransmitter GABA; anxiolytic, analgesic, and antiepileptic properties
Source page 1081
USES: Neuropathic pain associated with spinal cord injury/diabetic peripheral neuropathy, partial-onset seizures, postherpetic neuralgia, fibromyalgia
Source page 1081
Extracted information for pregabalin only.
CONTRAINDICATIONS: Hyper sensitivity to this product or gabapentin, abrupt discontinuation Precautions: Pregnancy, breastfeeding, children <12 yr, geriatric patients, renal disease, PR interval prolongation, cre- atine kinase elevations, HF (class III, IV), decreased platelets, substance abuse, dependence, glaucoma, myopathy, angio- edema history, suicidal behavior
Source page 1081
SIDE EFFECTS CNS: Dizziness, drowsiness abnormal thinking, suicidal ideation P EENT: Dry mouth, blurred vision, sinusitis GI: Constipation, abdominal pain, weight gain, nausea, vomiting, increased appetite GU: Gynecomastia HEMA: Thrombocytopenia MS: Back pain, rhabdomyolysis, myopathy OTHER: Pruritus, peripheral edema, angioedema
Source page 1081
INTERACTIONS Increase: weight gain/fluid retention— pioglitazone, rosiglitazone; avoid use if possible Increase: CNS depression—anxiolytics, sedatives, hypnotics, barbiturates, gen- eral anesthetics, opiate agonists, pheno- thiazines, sedating H1 blockers, thiazoli- dinediones, tricyclics, alcohol Increase: angioedema—ACE inhibitors Drug/Lab Test Increase: creatine kinase Decrease: platelets
Source pages 1081, 1082
TREATMENT OF OVERDOSE: Lavage, VS, hemodialysis
Source page 1082
Extracted information for pregabalin only.
DOSAGE AND ROUTES Diabetic peripheral neuropathic pain/postherpetic neuralgia • Adult: PO/ORAL SOL 50 mg tid, may increase to 300 mg/day (max) within 1 wk, adjust in patients with renal disease; EXT REL 165 mg/day, may increase to 330 mg/day (treatment-naive patients) Partial-onset seizures • Adult: PO/ORAL SOL 75 mg bid or 50 mg tid; may increase to 600 mg/day (max) Fibromyalgia, spinal cord injury pain • Adult: PO/ORAL SOL 75 mg bid, may increase to 150 mg bid within 1 wk and 225 mg bid after 1 wk Renal dose • Adult: PO CCr 30-60 mL/min, 75-300 mg/day in 2-3 divided doses; CCr 15-30 mL/min, 25-150 mg/day in 1-2 divided doses; CCr <15 mL/min, 25-75 mg/day as a single dose
Source page 1081
Available forms: Caps 25, 50, 75, 100, 150, 200, 225, 300 mg; oral sol 20 mg/ mL; ext rel tabs 82.5, 165, 330 mg
Source page 1081
Administer: • Do not crush or chew caps; caps may be opened and contents put in apple- sauce or dissolved in juice • Give without regard to meals • Gradually withdraw over 7 days; abrupt withdrawal may precipitate seizures • Ext rel tablets: do not split, crush, chew; to be taken after evening meal • Oral sol: should be written in mg and calculated to mL
Source page 1081
Extracted information for pregabalin only.
Assess: • Seizures: aura, location, duration, ac- tivity at onset, use seizure precautions • Pain: location, duration, characteris- tics if using for diabetic neuropathy, spi- nal cord injury, neuralgia • Renal studies: urinalysis, BUN, urine creatinine q3mo, creatine kinase; if markedly increased, discontinue product • Vision: monitor for blurred vision, nys- tagmus, amblyopia • CV/respiratory status: monitor B/P, HR, rhythm, breathing for dyspnea, crackles, wheezing • Mental status: mood, sensorium, af- fect, behavioral changes, suicidal thoughts/behaviors; if mental status changes, notify prescriber • Angioedema/hypersensitivity: (rare) monitor for blisters, hives, rash, dyspnea, wheezing; angioedema; if these occur, discontinue; cross-hypersensitivity with this product and gabapentin may occur • Rhabdomyolysis and creatinine kinase elevations (rare): monitor for muscle pain, tenderness, weakness ac- companied by malaise or fever; product should be discontinued • Beers: avoid in older adults unless safer alternative is unavailable; may cause ataxia, impaired psychomotor function • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk, may cause fetal toxicity; pregnant patients should enroll in the Antiepileptic Drug Pregnancy Registry, 1-888-233-2334; do not breast- feed
Source page 1082
Evaluate: • Therapeutic response: decreased sei- zure activity; decrease in neuropathic pain
Source page 1082
CLINICAL CONSIDERATIONS
Source page 1082
Patient and caregiver information: • To carry emergency ID stating patient’s name, products taken, condition, pre- scriber’s name and phone number • To avoid driving, other activities that require alertness because dizziness, drowsiness may occur, to obtain clear- ance from provider if driving is acceptable • Not to discontinue medication quickly after long-term use; to taper over ≥1 wk; that withdrawal-precipitated seizures may occur; not to double doses if dose is missed, to take if 2 hr or more before next dose • To notify prescriber if pregnancy is planned or suspected; to avoid breast- feeding • To report muscle pain, tenderness, weakness when accompanied by fever, malaise, suicidal thoughts/behaviors • To avoid alcohol, live virus vaccines
Source page 1082
Extracted information for pregabalin only.
PHARMACOKINETICS Well absorbed, peak 1.5 hr; 90% recov- ered in urine unchanged; negligible metabolism; not bound to plasma pro- teins; half-life 6 hr
Source page 1081
Filter the extracted dose blocks for this individual drug.
Diabetic peripheral neuropathic pain/postherpetic neuralgia
• Adult: PO/ORAL SOL 50 mg tid, may increase to 300 mg/day (max) within 1 wk, adjust in patients with renal disease; EXT REL 165 mg/day, may increase to 330 mg/day (treatment-naive patients) Partial-onset seizures
Candidate age grouping · source page 1081
Diabetic peripheral neuropathic pain/postherpetic neuralgia
• Adult: PO/ORAL SOL 75 mg bid or 50 mg tid; may increase to 600 mg/day (max) Fibromyalgia, spinal cord injury pain
Candidate age grouping · source page 1081
Diabetic peripheral neuropathic pain/postherpetic neuralgia
• Adult: PO/ORAL SOL 75 mg bid, may increase to 150 mg bid within 1 wk and 225 mg bid after 1 wk Renal dose
Candidate age grouping · source page 1081
Diabetic peripheral neuropathic pain/postherpetic neuralgia
• Adult: PO CCr 30-60 mL/min, 75-300 mg/day in 2-3 divided doses; CCr 15-30 mL/min, 25-150 mg/day in 1-2 divided doses; CCr <15 mL/min, 25-75 mg/day as a single dose
Candidate age grouping · source page 1081