Medications, Neuropathic

Pregabalin – Lyrica

The following information is NOT meant to be used to treat yourself or patients

  • Generic name= Pregabalin

    Image from Drugs.com
  • Trade name = Lyrica
  • Class = antiepileptic
  • MOA
    • binds to voltage-gated calcium channels and inhibits neurotransmitter release
  • Advantages
    • Efficacious against many neuropathic pain conditions
    • Linear pharmacokinetics = easier dosing
    • Pain relief quicker than gabapentin
    • FDA-approved for the treatment of diabetic peripheral neuropathy (2004), postherpetic neuralgia (2004), fibromyalgia (2007), and neuropathic pain associated with spinal cord injury (2012)
  • Dosing
    • Starting dose:  150 mg/day (divided BID or TID)
    • Titrating:
      • Increase to 300 mg/day (divided BID/TID) after 3-7 days
      • Then, increase by an extra 150 mg/day every 3-7 days
    • Max dose:  600 mg/day (200mg TID or 300mg BID)
    • Adequate trial period:  4 weeks
  • Note: Decreased dose in patients with renal disease
  • Note:  BID dosing is much more acceptable to patients
  • Most common adverse effects
    • Peripheral edema and weight gain
    • Ataxia, dizziness, somnolence, tremors
  • Insurance issues
    • Many insurances require failure of gabapentin first.  It’s important to note that they may push you to prescribe the patient gabapentin for an off-label Lyrica use such as chronic lumbar radiculopathy, but gabapentin is not FDA approved for that either.
    • In my area, BCBS, CareMark, and Express Scripts give us the least trouble with prescribing Lyrica
  • Patent expiration on December 30, 2018:  http://www.drugs.com/availability/generic-lyrica.html

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