//fpnotebook.com/
Pregabalin
Aka: Pregabalin, Lyrica
- 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]
- Indications
- Anticonvulsant
- Adjunct for partial-onset Seizures
- Neuropathic Pain Management
- Fibromyalgia
- Peripheral Neuropathy
- Diabetic Peripheral Neuropathy
- Postherpetic Neuralgia
- 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
- Safety
- First trimester use linked to possible birth defects
- Winterfeld (2016) Neurology 86(24): 2251-7 [PubMed]
- Adverse effects
- Common adverse effects
- Weight gain
- Peripheral Edema
- Dizziness or Ataxia
- Somnolence
- Headache
- Xerostomia
- Tremor
- Blurred Vision or Diplopia
- Severe but uncommon adverse effects
- Angioedema
- Hypersensitivity Reaction
- Rhabdomyolysis (rare)
- 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