II. Precautions: Risk of Abuse

  1. Gabapentin and Pregabalin (Lyrica) is abused by patients on Opiates to potentiate CNS Opiate effects
  2. More than one quarter of Opiate patients have abused Gabapentin
  3. Pregabalin (Lyrica) is more potent with faster onset and has higher abuse potential than Gabapentin
  4. Smith (2012) Br J Gen Pract 62(601):406-7 +PMID:22867659 [PubMed]

III. Indications

  1. Anticonvulsant
    1. Adjunct for partial-onset Seizures
  2. Neuropathic Pain Management
    1. Fibromyalgia
    2. Peripheral Neuropathy
      1. Diabetic Peripheral Neuropathy
      2. Postherpetic Neuralgia

IV. Mechanism

  1. Lipophilic (greater diffusion across blood brain barrier)
  2. Binds alpha2-delta1 subunit of Central Nervous System voltage-gated Calcium channels
  3. Does not bind GABA Receptors or Benzodiazepine receptors

V. Safety

  1. First trimester use linked to possible birth defects
    1. Winterfeld (2016) Neurology 86(24): 2251-7 [PubMed]

VI. Adverse effects

VII. Dosing

  1. Starting
    1. Dose: 25 mg orally three times daily (starting low dose maximizes tolerability)
  2. Titrate to effective dose in increments on weekly basis based on tolerability
  3. Maximum dose: 450 mg/day divided 2-3 times daily
    1. Fibromyalgia may require the maximum dose
  4. Stopping
    1. Taper off agent over 1 week or more
    2. Avoid stopping abruptly due to withdrawal symptoms

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Related Studies

Cost: Medications

pregabalin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PREGABALIN 100 MG CAPSULE Generic $0.07 each
PREGABALIN 150 MG CAPSULE Generic $0.08 each
PREGABALIN 200 MG CAPSULE Generic $0.09 each
PREGABALIN 225 MG CAPSULE Generic $0.09 each
PREGABALIN 25 MG CAPSULE Generic $0.07 each
PREGABALIN 300 MG CAPSULE Generic $0.10 each
PREGABALIN 50 MG CAPSULE Generic $0.07 each
PREGABALIN 75 MG CAPSULE Generic $0.08 each
lyrica (on 3/15/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LYRICA 100 MG CAPSULE Generic $0.07 each
LYRICA 150 MG CAPSULE Generic $0.08 each
LYRICA 200 MG CAPSULE Generic $0.09 each
LYRICA 225 MG CAPSULE Generic $0.09 each
LYRICA 300 MG CAPSULE Generic $0.10 each
LYRICA 50 MG CAPSULE Generic $0.07 each
LYRICA 75 MG CAPSULE Generic $0.08 each