Pregabalin

Ask A Pharmacist

Pregabalin Facts

Self medication is not recommended. Always discuss medication changes with your physician and pharmacist.

Name: pregabalin (pre gab’ a lin), Lyrica®   

Uses: 

Officially approved in Canada for the management of neuropathic pain associated with diabetic peripheral neuropathy and post-herpetic neuralgia. Both are types of “nerve pain”.

May 12, 2009 Canada officially added the approved indication for the management of pain associated with fibromyalgia.

How pregabalin works:

Pregabalin is an analgesic that decreases the release of neurotransmitters (chemicals) in the brain in response to pain. The decrease in the release of chemicals results in a decrease in pain felt by the patient.

Place in treatment:

Diabetic peripheral neuropathy, post-herpetic neuralgia and fibromyalgia are all complex pain disorders that often require multiple interventions to improve pain control. These include a combination of non-medication and medication. Since each person’s pain is different, responses to various pain medications vary. 

Chronic pain scientific studies consider 30-50% improvement in pain to be significant results. The goal of treatment is to decrease pain (not eliminate it completely), improve sleep and improve day to day activities.

Dose in fibromyalgia:

Start with 50-75mg at bedtime increasing slowly as tolerated to doses of 75-150mg twice daily. Some patients may need doses of 225mg twice daily but often the increased benefit is at the expense of increased side effects. The maximum recommended dose is 300mg twice daily.

The lower starting dose is for patients who are sensitive to medications. Other patients may start at 75mg twice daily for 1 week then increase to 150mg twice daily as tolerated.

Effects of pain relief may start after 1 week of treatment but full effects of the drug will take several weeks.

Pregabalin may be taken with or without food at the same times each day.

If you forget your dose and remember within a few hours then take the missed dose. If it is time for the next dose then do NOT take the missed dose (do not double the dose).

If stopping pregabalin then decrease the dose slowly over at least 1 week to prevent withdrawal symptoms (trouble sleeping, diarrhea, nausea, headaches or seizures). Always discuss this with your physician. 

Precautions:

Use pregabalin with caution if you have kidney dysfunction since the drug is excreted by the kidneys and the dose will need to be decreased.

Talk to your physician and pharmacist about the other prescribed medications, non-prescription medications including natural products you are taking to make sure there are no interactions with pregablin.

Alcohol will increase the drowsiness you feel with pregabalin.

Side Effects:

All medications that have positive effects (usefulness) also have negative effects (side effects). A balance between the two is necessary. Starting at a low dose and increasing the dose gradually decreases the chance of side effects.

Most common side effects with pregabalin are sleepiness, dizziness, blurred vision and weight gain. These effects usually go away while continuing to take pregabalin.

In most scientific studies the side effects were generally mild, and most patients continued taking pregabalin.

Sedation and dizziness can be minimized by taking the dose only at night or ¼ of the dose in the morning and ¾ of the dose at night to help with sleeping.

Swelling of the hands and feet require assessment by your physician. Some patients may respond to a mild diuretic (“water pill”).

Serious side effects to tell your doctor include face and neck swelling, skin rash, blisters or difficulty breathing.

Summary:

Pregabalin works the same way as gabapentin. Some patients unable to tolerate gabapentin may tolerate pregabalin. It can be helpful in controlling nerve pain and fibromyalgia pain. Discuss this option with your physician and pharmacist to see if it may be helpful in your pain management. Each patient’s pain is unique, and therefore the individual response to different treatments varies.

Janice E. Sumpton RPh., BScPhm.     May 19, 2009