Pharm
Pregabalin
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Pregabalin
, Lyrica
Precautions
Risk of Abuse
Gabapentin
and Pregabalin (Lyrica) is abused by patients on
Opiate
s 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
Seizure
s
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
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