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pregabalin (Rx)Brand and Other Names:Lyrica

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule: Schedule V

  • 25mg
  • 50mg
  • 75mg
  • 100mg
  • 150mg
  • 200mg
  • 225mg
  • 300mg

oral solution: Schedule V

  • 20mg/mL
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Diabetic Peripheral Neuropathic Pain

Initial: 50 mg PO q8hr

Maintenance: May increase to 100 mg PO q8hr within 1 week, as needed; not to exceed 300 mg/day

Postherpetic Neuralgia

Initial: 150-300 mg/day PO divided q8-12hr

Maintenance: May increase to 300 mg/day divided q8-12hr after 1 week, as needed

Fibromyalgia

Initial: 150 mg/day PO divided q12hr

Maintenance: May increase to 300-450 mg/day divided q12hr after 1 week, as needed

Epilepsy

Initial: 150 mg/d divided q8-12hr PO

Maintenance: May increase to 600 mg/day PO divided q8-12hr, as needed

Neuropathic Pain With Spinal Cord Injury

Initial: 150 mg/day PO divided q12hr; may increase within 1 week to 300 mg/day PO divided q12hr

If there is insufficient pain relief after 2-3 weeks and 300 mg/day dose is tolerated, may increase dose again up to 600 mg/day PO divided q12hr

Dosing Modifications

Renal impairment (CrCl 30-60 mL/min)

  • Decrease dose by 50% divided bid/tid

Renal impairment (CrCl 15-30 mL/min)

  • If 150 mg/day in normal renal function: Decrease dose to 25-50 mg/day; administer qDay or divided bid
  • If 300 mg/day in normal renal function: Decrease dose to 75 mg/day; administer qDay or divided bid
  • If 450 mg/day in normal renal function: Decrease dose to 100-150 mg/day; administer qDay or divided bid
  • If 600 mg/day in normal renal function: Decrease dose to 150 mg/day; administer qDay or divided bid

Renal impairment (CrCl <15 mL/min)

  • If 150 mg/day in normal renal function: Decrease dose to 25 mg/day; single daily dose
  • If 300 mg/day in normal renal function: Decrease dose to 25-50 mg/day; single daily dose
  • If 450 mg/day in normal renal function: Decrease dose to 50-75 mg/day; single daily doseof divided bid
  • If 600 mg/day in normal renal function: Decrease dose to 75 mg/day; single daily dose

Renal impairment (supplemental dosage following hemodialysis)

  • 25 mg qDay regimen: Take 1 supplemental dose of 25 mg or 50 mg
  • 25-50 mg qDay regimen: Take 1 supplemental dose of 50 mg or 75 mg
  • 50-75 mg qDay regimen: Take 1 supplemental dose of 75 mg or 100 mg
  • 75 mg qDay regimen: Take 1 supplemental dose of 100 mg or 150 mg

Safety and efficacy not established

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Interactions

Interaction Checker

pregabalin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Dose-dependent; percentages according to highest reported

            >10%

            Dizziness (8-45%)

            Somnolence (4-36%)

            Peripheral edema (16%)

            Ataxia (1-20%)

            Fatigue (5-11%)

            Xerostomia (1-15%)

            Weight gain (16%)

            Tremor (11%)

            Blurred vision (1-12%)

            Diplopia (12%)

            1-10%

            Asthenia (5%)

            Edema (8%)

            Facial edema (<3%)

            Hypotension (2%)

            Neuropathy (2-9%)

            Pain (5%)

            Disorientation (<2%)

            Constipation (5%)

            Weight gain (4%)

            Accidental injury (4%)

            Abnormal thinking (2%)

            Confusion (<7%)

            Amnesia (<6%)

            Vertigo (1-4%)

            Hypoesthesia (2-3%)

            Euphoria (2%)

            Decreased libido (>1%)

            Incoordination (2%)

            Vomiting (1-3%)

            Balance disorder (2-9%)

            Myoclonus (4%)

            Nasopharyngitis pain (1-3%)

            Flu-like syndrome (1-2%)

            <1%

            Addiction

            Anemia

            Diarrhea

            Gynecomastia and breast enlargement

            Epididymitis

            Esophagitis

            Dysmenorrhea

            Dystonia

            Heart failure

            Hirsutism

            Uveitis

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Discontinue gradually over at least 1 week

            Monitor for physical dependence and withdrawal symptoms

            Monitor for decreased platelet count (rare) and increased creatinine kinase levels

            May cause prolongation of PR interval

            May potentiate effects of other sedatives

            Rhabdomyolysis reported (monitor for muscle pain)

            History of angioedema, concurrency with drugs associated with angioedema risk (eg, ACEIs)

            Increased risk of peripheral edema, dizziness, somnolence, blurred vision, and weight gain

            Potential risk of male-mediated teratogenicity

            Use caution in cardiovascular disease (heart failure) and renal impairment

            May impair ability to drive or perform hazardous tasks

            Discontinue treatment if hypersensitivity occurs

            Do not discontinue anticonvulsants abruptly as that may increase seizure frequency

            Antiepileptic drugs increase risk of suicidal thoughts or behavior in patients taking these drugs for any indication; monitor for emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior

            Angioedema

            • Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported during initial and chronic treatment, including reports of life-threatening angioedema with respiratory compromise requiring emergency intervention
            • If laryngeal stridor or angioedema of the face, tongue, or glottis occurs, discontinue therapy and institute appropriate therapy immediately
            • Coadministration of ACE inhibitors or mTOR (mammalian target of rapamycin) inhibitors (eg, temsirolimus, sirolimus, everolimus), or previous history of angioedema may increase risk
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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Unknown if excreted in milk; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Precise mechanism of action unknown but is a GABA analogue that binds to a subunit of voltage-gated calcium channels in CNS; does not affect sodium channels, opiate receptors, or cyclo-oxygenase enzyme activity; interactions with descending noradrenergic and serotonergic pathways originating from the brain stem appear to reduce neuropathic pain transmission from spinal cord

            Absorption

            Bioavailability: >90%

            Peak plasma time: 1.5 hr

            Distribution

            Vd: 0.5 L/kg

            Protein bound: None

            Metabolism

            Minimal

            Elimination

            Half-life: 6.3 hr

            Excretion: Urine

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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