II. Precautions: Risk of Abuse
- Gabapentin and Pregabalin (Lyrica) is abused by patients on Opiates to potentiate CNS Opiate effects
- More than one quarter of Opiate patients have abused Gabapentin
- Pregabalin (Lyrica) is more potent with faster onset and has higher abuse potential than Gabapentin
- Smith (2012) Br J Gen Pract 62(601):406-7 +PMID:22867659 [PubMed]
III. Indications
- Anticonvulsant
- Adjunct for partial-onset Seizures
- Neuropathic Pain Management
IV. Mechanism
- Lipophilic (greater diffusion across blood brain barrier)
- Binds alpha2-delta1 subunit of Central Nervous System voltage-gated Calcium channels
- Does not bind GABA Receptors or Benzodiazepine receptors
V. Safety
- First trimester use linked to possible birth defects
VI. Adverse effects
- Common adverse effects
- Severe but uncommon adverse effects
VII. Dosing
- Starting
- Dose: 25 mg orally three times daily (starting low dose maximizes tolerability)
- Titrate to effective dose in increments on weekly basis based on tolerability
- Maximum dose: 450 mg/day divided 2-3 times daily
- Fibromyalgia may require the maximum dose
- Stopping
- Taper off agent over 1 week or more
- Avoid stopping abruptly due to withdrawal symptoms
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Related Studies
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 |