Pregabalin (Lyrica) - Complete Drug Information

Pregabalin (Lyrica) is a medicine that is used to treat a variety of conditions listed below. Mostly, it is used in the management of neuropathic pains (pains arising from nerves) and epilepsy.

  • Fibromyalgia (immediate release only):

    • It is used in the management of fibromyalgia

  • Neuropathic pain associated with diabetic peripheral neuropathy (immediate-release and extended-release):

    • It is used in the management of neuropathic pain associated with diabetic peripheral neuropathy

  • Neuropathic pain associated with spinal cord injury (immediate release only):

    • It is used in the management of neuropathic pain associated with spinal cord injury

  • Postherpetic neuralgia (immediate-release and extended-release):

    • It is used in the management of postherpetic neuralgia

  • Seizures, focal (partial) onset (immediate release only):

    • It is used as adjunctive therapy in patients ≥4 years of age with focal onset (partial-onset) seizures

  • Off Label Usage of Pregabalin in Adults:

    • Chronic refractory cough;
    • Generalized anxiety disorder;
    • Postoperative pain
    • Pruritus, neuropathic or malignancy-related;
    • Pruritus, uremic;
    • Restless legs syndrome;
    • Social anxiety disorder;
    • Vasomotor symptoms  with menopause

Pregabalin Dose in Adults

  •  When discontinuing, taper off slowly over at least 7 days.

Off label dose as an alternative agent in the treatment of Cough, chronic refractory :

  • Immediate release:

    • Initially 75 mg orally once daily is given
    • It can be increased gradually over the first week in increments of 75 mg/day based on response and tolerability up to a maximum dose of 300 mg/day in 3 divided doses

Dosage as an alternative agent in the treatment of Fibromyalgia:

  • Immediate release:

    • Initially 75 mg orally twice daily is given
    • It may be increased to 150 mg twice daily within 1 week based on response and tolerability
    • The maximum dose is 450 mg/day

Dosage as an alternative agent in the treatment of Generalized anxiety disorder (Off label):

  • It is used as Monotherapy or adjunctive therapy for patients who do not tolerate or respond to preferred agents.

  • Immediate release:

    • Initially, 150 mg/day orally in 2 to 3 divided doses is given
    • It may be increased based on response and tolerability at weekly intervals in increments of 150 mg/day up to a usual dose of 300 mg/day.
    • It can be further increased up to 600 mg/day

Dose in the treatment of Neuropathic pain:

  • Immediate release:

    • Initially 25 to 150 mg/day orally once daily is given or in 2 divided doses
    • It may be increased in increments of 25 to 150 mg/day at intervals more than 1 week based on response and tolerability up to a usual dose of 300 to 600 mg/day in 2 divided doses

Dose in the treatment of diabetic neuropathy:

  • Immediate release:

    • Initially 25 to 75 mg/day orally once daily is given or in 2 to 3 divided doses
    • It may be increased within 7 days based on response and tolerability up to a maximum dose of 300 to 450 mg/day .
    • Higher doses may be associated with greater adverse effects without additional benefits

  • Extended-release:

    • Initially 165 mg orally once daily is given
    • It may be increased within 1 week based on response and tolerability up to a maximum dose of 330 mg once daily.

Dosage in the treatment of Postherpetic neuralgia:

  • Immediate release:

    • Initially, 150 mg/day orally is given in divided doses (75 mg twice daily or 50 mg 3 times daily)
    • It may be increased to 300 mg/day within 7 days based on response and tolerability
    • It can b increased after 2 to 4 weeks, up to the maximum dose of 600 mg/day.

  • Extended-release:

    • Initially 165 mg orally once daily is given
    • It may be increased to 330 mg once daily within 1 week based on response and tolerability
    • It can b increased after 2 to 4 weeks, up to the maximum dose of 660 mg/day

Dose in the treatment of Spinal cord injury-associated neuropathic pain:

  • Immediate release:

    • Initially, 75 mg twice daily is given
    • It may b increased within 1 week based on response and tolerability to 150 mg twice daily
    • after 2 to 3 weeks, can further be increased up to a maximum of 600 mg/day.

Dose in the treatment of Postoperative pain (off-label):

  • Immediate-release:
    • 75 to 300 mg is given orally as a single dose
    • 1 to 2 hours before surgery as part of a multimodal analgesia regimen.

Dose as an alternative agent in the treatment of chronic Pruritus (off-label):

  • For patients with pruritus resistant to preferred therapies.

Dosage in the treatment of Neuropathic (eg, brachioradial pruritus, notalgia paresthetica) or malignancy-related: 

  • Immediate release:
    • The initial dose is  75 mg orally twice daily
    • It may be increased based on response and tolerability up to 150 to 300 mg/day in 2 to 3 divided doses
    • Higher doses (up to 600 mg/day) have been used in oncology populations

Dose in the treatment of Uremic:

  • Immediate release:
    • 50 mg orally given every other day given after dialysis on hemodialysis days
    •                                              or
    • 25 mg daily given, each increased based on response and tolerability to 50 or 75 mg daily
    •                                              or
    • 75 mg twice weekly given after dialysis on hemodialysis days also appears effective.

Dose in the treatment of Restless legs syndrome (off-label):

  • Immediate release:
    • The initial dose is  50 to 75 mg orally once daily
    • It is given 1 to 3 hours before bedtime
    • It gradually increases (eg, in increments of 75 to 150 mg) every 5 to 7 days according to response and tolerability to a usual effective dose of 150 to 450 mg/day.

Dose in the treatment of Seizures, focal (partial) onset (adjunctive therapy with other anticonvulsants):

  • Immediate release:
    • The initial dose is 150 mg/day orally in 2 or 3 divided doses
    • It may be increase based on response and tolerability at weekly intervals up to a maximum dose of 600 mg/day.

Dosage as an alternative agent in the treatment of Social anxiety disorder (off-label):

  • For patients who do not tolerate or respond to preferred agents, monotherapy or adjunctive therapy may be used.

  • Immediate-release:

    • The initial dose is 100 mg orally 3 times daily
    • It may be increased over 1 week in increments of 150 mg/day based on response and tolerability up to 600 mg/day

Off-label dosage in the treatment of Vasomotor symptoms associated with menopause (alternative agent):

  • It is used as a nonhormonal alternative in patients unable or unwilling to take preferred agents

  • Immediate-release:

    • The initial dose is  50 mg orally once daily at bedtime
    • It may be increased at weekly intervals based on response and tolerability to 50 mg twice daily, and then up to 75 mg twice daily
    • It may further increase up to 150 mg twice daily.

  • Dosing conversion from immediate-release oral formulations to the extended-release oral formulation:

  • Give morning dose of the immediate-release product as prescribed, and initiate extended-release therapy after the evening meal on the day of the switch.
    • The immediate-release total daily dose of 75 mg is equal to the extended-release dose of 82.5 mg once daily.
    • The immediate-release total daily dose of 150 mg is equal to the extended-release dose of 165 mg once daily.
    • The immediate-release total daily dose of 225 mg is equal to the extended-release dose of 247.5 mg once daily.
    • The immediate-release total daily dose of 300 mg is equal to the extended-release dose of 330 mg once daily.
    • The immediate-release total daily dose of 450 mg is equal to the extended-release dose of 495 mg once daily.
    • The immediate-release total daily dose of 600 mg is equal to the extended-release dose of 660 mg once daily.

  • Discontinuation of therapy:

    • Unless safety concerns require a more rapid withdrawal, pregabalin should be withdrawn gradually over more than 1 week to lessen the potential of increased seizure frequency (in patients with epilepsy) or other withdrawal symptoms (eg, agitation, confusion, delirium, delusions, GI symptoms, mood changes, sweating, withdrawal seizures).

Pregabalin Dose in Children

  • When discontinuing, taper off slowly over at least 1 week.

Dose in the treatment of partial-onset Seizures as adjunctive therapy:

  • Immediate release:

    • Children ≥4 years and Adolescents <17 years:

    • 11 to <30 kg:

      • The initial dose is 3.5 mg/kg/day orally in 2 or 3 divided doses
      • It may be increased weekly based on clinical response and tolerability
      • maximum daily dose: 14 mg/kg/day

    • ≥30 kg:

      • The initial dose is  2.5 mg/kg/day orally in 2 or 3 divided doses
      • The dose may be increased weekly based on clinical response and tolerability
      • The maximum daily dose is 10 mg/kg/day not to exceed 600 mg/day

    • Adolescents ≥17 years:

      • The initial dose is 150 mg orally daily in 2 or 3 divided doses
      • It may be increased weekly based on tolerability and effect
      • The maximum daily dose is 600 mg/day

Pregnancy Risk factor: C

  • Pregabalin can cross the placenta
  • Data collection to monitor pregnancy and infant outcomes following exposure to pregabalin is underway.

Pregabalin use during breastfeeding:

  • Pregabalin is usually present in breast milk.
  • The relative infant dose (RID) of pregabalin is ~7% when calculated by an average breast milk concentration compared to a weight-adjusted maternal dose of 300 mg/day.
  • In general, breastfeeding acceptable when the RID of medication is <10%.
  • Breastfeeding is not advised by the manufacturer.

Pregabalin dose in Renal Disease:

Immediate-release:

  • The Cockcroft-Gault formula can be used to estimate renal function.
  • Calculate the recommended dosage regimen using the indicated-specific daily dose for normal kidney function (CrCl>=60 mL/minute).

Pregabalin Renal Impairment Dosing - Immediate Release Pregabalin

CrCl (mL/minute). Daily Total Pregabalin Dosage (mg/day).   Frequency of Dosing
>=60 (normal renal function). 150 300 450 600 Divided doses of 2 to 3
30-60 75 150 225 300 Divided doses of 2 to 3

Hemodialysis: Dialyzable (50%), supplementary dose post-hemodialysis (as one additional dose):

25 mg/day schedule One additional dose of 25mgOr50 mg Schedule: 25-50 mg/day One additional dose of 50mgOr75 mg Schedule: 50-75 mg/day One additional 75 mg doseOr100 mg Schedule: 75 mg/day One additional 100 mg doseOr150 mg
CrCl (mL/minute). Daily Total Pregabalin Dosage (mg/day).   Dosing Frequency
15-30 25-50 75 100 to 150 150 Divided doses: 1 to 2
15 25 25-50 50-75 75 One daily dose

Hemodialysis: Dialyzable (50%), supplementary dose post hemodialysis (a single additional dosage):

25 mg/day schedule One additional dose of 25mgOr50 mg Schedule: 25-50 mg/day One additional dose of 50mgOr75 mg Schedule: 50-75 mg/day One additional 75 mg doseOr100 mg Schedule: 75 mg/day One additional 100 mg doseOr150 mg

Extended-release

  • The Cockcroft-Gault formula can be used to evaluate renal function.
  • Calculate the recommended dosage regimen using the indicated total daily dose for normal kidney function (CrCl >=60mL/minute).

Extended-Release Pregabalin dosage in Renal Impairment

CrCl (mL/minute). Total Pregabalin Daily Dose (mg/day).   Dosing Frequency
>=60 (normal renal function). 165 330 495 660 Once-daily
30-60 82.5 165 247.5 330 Once-daily
30 Not recommended for extended-release products; instead, use immediate-release products
Hemodialysis

Pregabalin Dose in Liver Disease:

  • There are no dosage adjustments given in the manufacturer's labeling.

Common Side Effects of Pregabalin (Lyrica) Include:

  • Cardiovascular:

    • Peripheral Edema

  • Central Nervous System:

    • Dizziness
    • Drowsiness
    • Headache
    • Fatigue

  • Endocrine & Metabolic:

    • Weight Gain

  • Gastrointestinal:

    • Xerostomia

  • Ophthalmic:

    • Visual Field Loss
    • Blurred Vision

Less Common Side Effects of Pregabalin (Lyrica) Include:

  • Cardiovascular:

    • Edema
    • Facial Edema
    • Chest Pain
    • Hypertension
    • Hypotension

  • Central Nervous System:

    • Ataxia
    • Equilibrium Disturbance
    • Abnormal gait
    • Euphoria
    • Confusion
    • Disturbance In Attention
    • Abnormality In Thinking
    • Neuropathy
    • Pain
    • Myasthenia
    • Insomnia
    • Amnesia
    • Memory Impairment
    • Vertigo
    • Hypoesthesia
    • Feeling Abnormal
    • Speech Disturbance
    • Anxiety
    • Paresthesia
    • Disorientation
    • Intoxicated Feeling
    • Lethargy
    • Anorgasmia
    • Depersonalization
    • Hypertonia
    • Sedation
    • Stupor
    • Twitching
    • Nervousness

  • Dermatologic:

    • Pressure Ulcer
    • Ecchymoses
    • Pruritus
    • Contact Dermatitis

  • Endocrine & Metabolic:

    • Fluid Retention
    • Hypoglycemia
    • Decreased Libido

  • Gastrointestinal:

    • Constipation
    • Increased Appetite
    • Nausea
    • Sialorrhea
    • Flatulence
    • Vomiting
    • Abdominal Distension
    • Abdominal Pain
    • Gastroenteritis
    • Diarrhea
    • Viral Gastroenteritis

  • Genitourinary:

    • Urinary Incontinence
    • Impotence
    • Urinary Frequency
    • Erectile Dysfunction
    • Urinary Tract Infection

  • Hematologic & Oncologic:

    • Thrombocytopenia

  • Hepatic:

    • Increased Serum Alanine Aminotransferase
    • Increased Serum Aspartate Aminotransferase

  • Hypersensitivity:

    • Hypersensitivity Reaction

  • Infection:

    • Infection

  • Neuromuscular & Skeletal:

    • Asthenia
    • Arthralgia
    • Muscle Spasm
    • Back Pain
    • Limb Pain
    • Neck Pain
    • Increased Creatine Phosphokinase
    • Tremor
    • Joint Swelling
    • Lower Limb Cramp
    • Myalgia

  • Ophthalmic:

    • Decreased Visual Acuity
    • Visual Disturbance
    • Diplopia
    • Eye Disease
    • Conjunctivitis
    • Nystagmus

  • Otic:

    • Otitis Media
    • Tinnitus

  • Respiratory:

    • Nasopharyngitis
    • Sinusitis
    • Bronchitis
    • Pharyngolaryngeal Pain
    • Dyspnea
    • Flu-Like Symptoms
    • Cough
    • Respiratory Tract Infection

  • Miscellaneous:

    • Accidental Injury
    • Fever

Very rare side effects of Pregabalin:

  • Cardiovascular:

    • Prolongation P-R interval on ECG is seen

Contraindication to Pregabalin Include:

  • Hypersensitivity to pregabalin (or any part thereof) can result in angioedema.

Warnings and precautions

  • Angioedema

    • Angioedema can be seen in both chronic and initial treatment. It may even prove to be life-threatening.
    • The most common symptoms include swelling of the neck, throat, larynx, and tongue (tongue and lips), as well as the mouth (tongue and lips) and facial areas.
    • Patients with angioedema episodes should be cautious.
    • Combining angioedema-causing drugs (eg, ACE inhibitors), could increase the risk.
    • If angioedema develops, stop treatment immediately.

  • CNS effects

    • Common symptoms include dizziness and somnolence
    • Most effects occur within a few hours of initiation. They also occur more often at higher doses.
    • It is important to inform patients about tasks that require mental alertness, such as driving or operating machinery.

  • Hematologic effects

    • It could decrease platelet count.
    • Extremely rare is severe thrombocytopenia.

  • Hypersensitivity

    • After treatment began, hypersensitivity reactions such as skin reddening, blistering, hives and dyspnea were seen quickly.
    • If hypersensitivity develops, stop the treatment.

  • Peripheral edema

    • Peripheral edema could result from prolonged use
    • Due to the limited data available, patients with heart failure (NYHA Class IV or III) should be used with caution.
    • Additionally, the effect of the Thiazolidinedione class antidiabetic drugs may be additive; caution is advised when administering these agents together, especially in patients with previous cardiovascular disease.

  • PR interval:

    • It can cause mild prolongation in the PR interval.
    • It is not known if clinical significance exists.

  • Rhabdomyolysis

    • It has been linked to increases in creatine Kinase, and rare cases of Rhabdomyolysis.
    • Patients should be directed to inform their doctor if they experience any muscle pain, tenderness or weakness.
    • If myopathy is suspected, diagnosed, or if creatine kinase levels are elevated, stop treatment.

  • Suicidal thoughts:

    • All patients should be evaluated for any changes in behavior that could indicate suicidal thoughts and/or depression.
    • If you experience symptoms, immediately notify your doctor.

  • Visual disturbances

    • Therapy has been shown to reduce blurred vision, visual field changes, and decreased acuity.
    • Patients should be told to inform their doctor if they notice any of these symptoms.

  • Weight loss

    • Weight gain could result from using
    • Weight gain is usually associated with dosage and duration

  • Cardiovascular disease

    • Patients with severe cardiovascular disease (including heart failure) should be cautious. Weight gain and/or peripheral swelling may also occur.
    • Pregabalin was also found to be an agent that can exacerbate myocardial dysfunction.

  • Renal impairment

    • Patients with impaired renal function should be cautious
    • Adjustment of dosage is necessary.

  • Substance abuse

    • Patients with a history or substance abuse should be cautious
    • This population is susceptible to behavioral dependence

Pregabalin: Drug Interaction

Risk Factor C (Monitor therapy)

Alcohol (Ethyl)

CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl).

Alizapride

May enhance the CNS depressant effect of CNS Depressants.

Angiotensin-Converting Enzyme Inhibitors

May enhance the adverse/toxic effect of Pregabalin. Specifically, the risk of angioedema may be increased.

Brimonidine (Topical)

May enhance the CNS depressant effect of CNS Depressants.

Bromopride

May enhance the CNS depressant effect of CNS Depressants.

Cannabidiol

May enhance the CNS depressant effect of CNS Depressants.

Cannabis

May enhance the CNS depressant effect of CNS Depressants.

Chlorphenesin Carbamate

May enhance the adverse/toxic effect of CNS Depressants.

CNS Depressants

May enhance the adverse/toxic effect of other CNS Depressants.

Dimethindene (Topical)

May enhance the CNS depressant effect of CNS Depressants.

Doxylamine

May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended.

Dronabinol

May enhance the CNS depressant effect of CNS Depressants.

Esketamine

May enhance the CNS depressant effect of CNS Depressants.

HydrOXYzine

May enhance the CNS depressant effect of CNS Depressants.

Kava Kava

May enhance the adverse/toxic effect of CNS Depressants.

Lofexidine

May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.

Magnesium Sulfate

May enhance the CNS depressant effect of CNS Depressants.

MetyroSINE

CNS Depressants may enhance the sedative effect of MetyroSINE.

Mianserin

May diminish the therapeutic effect of Anticonvulsants.

Minocycline

May enhance the CNS depressant effect of CNS Depressants.

Mirtazapine

CNS Depressants may enhance the CNS depressant effect of Mirtazapine.

Nabilone

May enhance the CNS depressant effect of CNS Depressants.

Orlistat

May decrease the serum concentration of Anticonvulsants.

Piribedil

CNS Depressants may enhance the CNS depressant effect of Piribedil.

Pramipexole

CNS Depressants may enhance the sedative effect of Pramipexole.

ROPINIRole

CNS Depressants may enhance the sedative effect of ROPINIRole.

Rotigotine

CNS Depressants may enhance the sedative effect of Rotigotine.

Rufinamide

May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.

Selective Serotonin Reuptake Inhibitors

CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.

Tetrahydrocannabinol

May enhance the CNS depressant effect of CNS Depressants.

Tetrahydrocannabinol and Cannabidiol

May enhance the CNS depressant effect of CNS Depressants.

Thiazolidinediones

Pregabalin may enhance the fluid-retaining effect of Thiazolidinediones.

Trimeprazine

May enhance the CNS depressant effect of CNS Depressants.

Risk Factor D (Consider therapy modification)

Blonanserin

CNS Depressants may enhance the CNS depressant effect of Blonanserin.

Buprenorphine

CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine patches (Butrans brand) at 5 mcg/hr in adults when used with other CNS depressants.

Chlormethiazole

May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.

Droperidol

May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs.

Flunitrazepam

CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.

HYDROcodone

CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.

Mefloquine

May diminish the therapeutic effect of Anticonvulsants. Mefloquine may decrease the serum concentration of Anticonvulsants. Management: Mefloquine is contraindicated for malaria prophylaxis in persons with a history of convulsions. Monitor anticonvulsant concentrations and treatment response closely with concurrent use.

Methotrimeprazine

CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.

Opioid Agonists

CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.

OxyCODONE

CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.

Perampanel

May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.

Sodium Oxybate

May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated.

Suvorexant

CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.

Tapentadol

May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.

Zolpidem

CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.

Risk Factor X (Avoid combination)

Azelastine (Nasal)

CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).

Bromperidol

May enhance the CNS depressant effect of CNS Depressants.

Orphenadrine

CNS Depressants may enhance the CNS depressant effect of Orphenadrine.

Oxomemazine

May enhance the CNS depressant effect of CNS Depressants.

Paraldehyde

CNS Depressants may enhance the CNS depressant effect of Paraldehyde.

Thalidomide

CNS Depressants may enhance the CNS depressant effect of Thalidomide.

Monitor:

  • Measuring efficacy (pain intensity/seizure frequency).
  • Graduation of sedation
  • Myopathy symptoms
  • Creatine kinase (as indicated clinically)
  • Ocular disturbances can be symptomatic
  • Weight gain/edema
  • Skin integrity in patients with diabetes
  • Suicidality signs and symptoms (eg suicidal thoughts or behavior changes, anxiety, depression, and/or suicidal thoughts)
  • Platelet count (as indicated by clinical evidence)

How to take Pregabalin (Lyrica)?

Instant-release

  • You can take it with or without food.

Extended-release

  • After an evening meal, give once daily
  • Take whole. Do not chew, split, crush or chew.
  • After eating a snack, a missed dose should not be taken before bedtime.
  • Do not eat if you are late for bed.
  • If you miss your morning dose, wait until dinner to get the next one.

Mechanism of action of Pregabalin (Lyrica):

  • It binds with the alpha-2 delta subunit of voltage-gated Calcium channels in the CNS and modifies calcium influx at nerve terminals.
  • This inhibits excitatory neurotransmitter releases including glutamate (noradrenaline), dopamine, substance, and calcitonin-related peptide.
  • It is structurally similar to GABA but does not bind to GABA and benzodiazepine receptors.
  • It has antinociceptive, anticonvulsant and other activities.
  • It could also affect the descending serotonergic and noradrenergic pain transmission pathways, which run from the brainstem down to the spinal cord.

The beginning of actionPain management:

  • You may notice its effects as soon as the first week of therapy.

AbsorptionExtended-release:

  • Fasting results in a 30% reduction in AUC

Distribution: V

  • 0.5 L/kg

Protein binding:

  • 0%

Metabolism:

  • Negligible

Bioavailability:

  • >=90%

Eliminating half-life:

  • Children aged 4-6 years: 3-4 hours
  • Children >=7 Years and Adolescents >17 years: 4-6 hours
  • Adults can stay for 6.3 hours

Plasma peak time:

  • Extended-release: Median 8 hours with food (range 5-12 hours).
  • Instant release: Adolescents >=17 years, Children >=4 Years: 0.5 to 2 Hours fasting
  • Median: 0.7 Hours fasting (range: 0.0.7 to 1.5 hours), 3 Hours with food

Excretion:

  • Via Urine (90% unchanged drug; minor metabolites) 

International Brands of Pregabalin:

  • ACT Pregabalin
  • AG-Pregabalin
  • APO-Pregabalin
  • Auro-Pregabalin
  • DOM-Pregabalin
  • GD-Pregabalin
  • JAMP-Pregabalin
  • Lyrica
  • M-Pregabalin
  • Mar-Pregabalin
  • MINT-Pregabalin
  • MYL-Pregabalin
  • MYLAN-Pregabalin
  • NRA-Pregabalin
  • PMS-Pregabalin
  • Pregabalin-150
  • Pregabalin-25
  • Pregabalin-50
  • Pregabalin-75
  • RAN-Pregabalin
  • RIVA-Pregabalin
  • SANDOZ Pregabalin
  • TEVA-Pregabalin
  • Algecia
  • Andogablin
  • Aprion
  • Axual
  • Balinozar
  • Brieka
  • Egzsta
  • Erclany
  • Funxion
  • Gabarol
  • Gabi
  • Gabica
  • Gabrika
  • Galica
  • Gavin
  • Gloryca
  • Innikra
  • Kemirica
  • Lecaent
  • Leptica
  • Ligaba
  • Linefor
  • Lingabat
  • Lipapyn
  • Lybalin
  • Lyrica
  • Lyrigab
  • Martesia
  • Neo Gaba
  • Neogabin
  • Nervax
  • Nervica
  • Neugalin
  • Neurocover-PG
  • Neurovan
  • Neurum
  • PGB
  • Plenica
  • Prebarin
  • Prebicta
  • Prega 150
  • Pregabadin
  • Pregadex
  • Pregalex
  • Pregalin
  • Pregasafe-150
  • Pregax
  • Pregeb
  • Prelyx
  • Preneurin
  • Prex
  • Provelyn
  • Regab
  • Rewisca
  • Silica
  • Toprelin
  • Vexer
  • Xablin
  • Zeegap
  • Zyzyx

Pregabalin brands in Pakistan:

Pregabalin [Caps 50 Mg]
Gabica Getz Pharma Pakistan (Pvt) Ltd.
Hilin Highnoon Laboratories Ltd.
Prelin Martin Dow Pharmaceuticals (Pak) Ltd.
Regab Caraway Pharmaceuticals
Syngab Atco Laboratories Limited
Xaar Wilshire Laboratories (Pvt) Ltd.
Zeegap Hilton Pharma (Pvt) Limited

Pregabalin [Caps 75 Mg]
Breglin Brookes Pharmaceutical Laboratories (Pak.) Ltd.
Gabica Getz Pharma Pakistan (Pvt) Ltd.
Gablin Consolidated Chemical Laboratories (Pvt) Ltd.
Hilin Highnoon Laboratories Ltd.
Lyrica Pfizer Laboratories Ltd.
Megab Capsule Sante (Pvt) Limited
Pegalin Shaigan Pharmaceuticals (Pvt) Ltd
Prelin Martin Dow Pharmaceuticals (Pak) Ltd.
Regab Caraway Pharmaceuticals
Xaar Wilshire Laboratories (Pvt) Ltd.
Zeegap Hilton Pharma (Pvt) Limited

Pregabalin [Caps 100 Mg]
Gabica Getz Pharma Pakistan (Pvt) Ltd.
Hilin Highnoon Laboratories Ltd.
Prelin Martin Dow Pharmaceuticals (Pak) Ltd.
Regab Caraway Pharmaceuticals
Syngab Atco Laboratories Limited
Xaar Wilshire Laboratories (Pvt) Ltd.
Zeegap Hilton Pharma (Pvt) Limited

Pregabalin [Caps 150 Mg]
Breglin Brookes Pharmaceutical Laboratories (Pak.) Ltd.
Gabica Getz Pharma Pakistan (Pvt) Ltd.
Gablin Consolidated Chemical Laboratories (Pvt) Ltd.
Hilin Highnoon Laboratories Ltd.
Lyrica Pfizer Laboratories Ltd.
Megab Capsule Sante (Pvt) Limited
Pegalin Shaigan Pharmaceuticals (Pvt) Ltd
Prelin Martin Dow Pharmaceuticals (Pak) Ltd.
Regab Caraway Pharmaceuticals
Zeegap Hilton Pharma (Pvt) Limited

Pregabalin [Caps 200 Mg]
Syngab Atco Laboratories Limited
Xaar Wilshire Laboratories (Pvt) Ltd.

Pregabalin [Caps 300 Mg]
Aropen Hygeia Pharmaceuticals
Gabica Getz Pharma Pakistan (Pvt) Ltd.
Gablin Consolidated Chemical Laboratories (Pvt) Ltd.
Hilin Highnoon Laboratories Ltd.
Lyrica Pfizer Laboratories Ltd.
Megab Capsule Sante (Pvt) Limited
Pegalin Shaigan Pharmaceuticals (Pvt) Ltd
Prelin Martin Dow Pharmaceuticals (Pak) Ltd.
Xaar Wilshire Laboratories (Pvt) Ltd.
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