Pregabalin
LYRICA
Pronunciation: pre-GAB-a-lin (LEER-i-ka)
“Preg gobblin’ Lyrics”
What it isAlpha-2-delta subunit ligand; neuropathic pain, fibromyalgia and adjunctive seizures.
Why this oneLinear, predictable absorption unlike gabapentin, so dosing is more reliable.
What limits itRenally cleared, and it accumulates. Sedation, weight gain and edema; it is Schedule V, with recognized misuse.
FDA-approved for
- neuropathic pain (2004)
- seizures (2004)
- fibromyalgia (2007)
Off-label
- GAD
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Diabetic peripheral neuropathic pain | Adult | 50 mg TID (150 mg/day) | 300 mg/day | 300 mg/day |
| Postherpetic neuralgia | Adult | 75 mg BID or 50 mg TID (150 mg/day) | 150-300 mg/day | 600 mg/day |
| Adjunctive partial-onset seizures | Adult (≥17 yr) | 150 mg/day (BID or TID) | per response | 600 mg/day |
| Adjunctive partial-onset seizures | Peds ≥30 kg | 2.5 mg/kg/day (BID or TID) | per response | 10 mg/kg/day (≤600 mg/day) |
| Adjunctive partial-onset seizures | Peds <30 kg | 3.5 mg/kg/day (1 mo-<4 yr TID; ≥4 yr BID/TID) | per response | 14 mg/kg/day |
| Fibromyalgia | Adult | 75 mg BID (150 mg/day) | 300-450 mg/day | 450 mg/day |
| Neuropathic pain w/ spinal cord injury | Adult | 75 mg BID (150 mg/day) | 300 mg/day | 600 mg/day |
Titration Adult: may increase to target within 1 week; pediatric seizures: increase approximately weekly
Renal Adjust dose by creatinine clearance (CLcr); reduce in CLcr <60 mL/min per label Table 2; supplemental dose after hemodialysis
Hepatic Undefined
Instructions
- Take orally with or without food
- Taper gradually over a minimum of 1 week when discontinuing — do not stop abruptly
Available strengths
- cap 25, 50, 75, 100, 150, 200, 225, 300 mg
- sol 20 mg/mL
- ER tab 82.5, 165, 330 mg
Cautions
- Angioedema (face/mouth/neck) — discontinue immediately
- Hypersensitivity reactions (hives, dyspnea, wheezing)
- Increased risk of suicidal thoughts/behavior
- Withdrawal seizures with abrupt discontinuation
- Respiratory depression with CNS depressants or respiratory impairment
- Dizziness/somnolence — driving impairment
- Peripheral edema (caution with thiazolidinediones); weight gain
Adverse reactions
- Dizziness, somnolence
- Dry mouth, peripheral edema
- Blurred vision, weight gain
- Abnormal thinking (concentration/attention)
- Pediatric: increased weight and appetite
Pregnancy Observational data suggest possible small increase in major birth defects; pregnancy exposure registry available
Lactation Breastfeeding not recommended
Cost
| Strength | #/mo | generic $ | CostPlus | |
|---|---|---|---|---|
| 25 mg | cap | 90 TID | $3.73/mo | not offered |
| 50 mg | cap | 90 TID | $4.24/mo | not offered |
| 75 mg | cap | 90 TID | $4.75/mo | not offered |
| 100 mg | cap | 90 TID | $5.14/mo | not offered |
| 150 mg | cap | 90 TID | $4.88/mo | not offered |
| 200 mg | cap | 90 TID | $5.34/mo | not offered |
| 225 mg | cap | 90 TID | $5.71/mo | not offered |
| 300 mg | cap | 90 TID | $5.99/mo | not offered |
| 20 mg/mL | sol | per unit | $0.15/mL | not offered |
Generic entry2019
NO BOXED WARNINGS
Principal riskSedation and edema; additive with opioids
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, edema and misuse/dependence potential; respiratory depression increases with opioids.
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