Pregabalin

Oral
Adjunct in partial seizures, Epilepsy

Oral
Fibromyalgia

Oral
Neuropathic pain

Oral
Anxiety

Haemodialysis: Initially, 25mg daily. Max: 100 mg daily. Administered as a single supplementary dose.

CrCl	Dosage
<15	Initially, 25 mg daily. Max: 75 mg daily. Administered as a single dose.
≥15-<30	Initially, 25-50 mg daily. Max: 150 mg daily. All doses given once daily or bid.
≥30-<60	Initially, 75 mg daily. Max: 300 mg daily. All doses given bid-tid.
≥60	Initially, 150 mg. Max: 600 mg. All doses given bid-tid.

May be taken with or without food.
extended-release tab: Should be taken with food. Take after an evening meal. Do not split/crush/chew.

Patients with CV disease (including heart failure), history of angioedema episodes or substance abuse. Elderly. Renal impairment. Pregnancy and lactation.

Significant: Hypersensitivity, peripheral oedema, dizziness, somnolence, visual disturbance, suicidal ideation, reduced platelet count, rhabdomyolysis, creatinine kinase elevations, weight gain, PR prolongation.
Blood and lymphatic system disorders: Neutropenia.
Cardiac disorders: Tachycardia, atrioventricular block first degree, sinus bradycardia, CHF.
Ear and labyrinth disorders: Vertigo, hyperacusis.
Eye disorders: Blurred vision, diplopia, peripheral vision loss, eye swelling, visual field defect, visual acuity reduced, eye pain, asthenopia, photopsia, dry eye, lacrimation increased, eye irritation.
Gastrointestinal disorders: Nausea, vomiting, constipation, diarrhoea, flatulence, abdominal distention, dry mouth, GERD, salivary hypersecretion, hypoaesthesia oral.
General disorders and administration site conditions: Oedema, abnormal gait, fatigue, pyrexia, thirst, chills, asthenia.
Hepatobiliary disorders: Elevated liver enzymes.
Metabolism and nutrition disorders: Appetite increased, anorexia, hypoglycaemia.
Musculoskeletal and connective tissue disorders: Muscle cramp, arthralgia, back pain, pain in limb, cervical spasm, joint swelling, myalgia, muscle twitching, neck pain, muscle stiffness.
Nervous system disorders: Headache, ataxia, abnormal coordination, tremor, dysarthria, amnesia, memory impairment, disturbance in attention, paraesthesia, hypoaesthesia, sedation, balance disorder, lethargy.
Psychiatric disorders: Euphoric mood, confusion, irritability, disorientation, insomnia, hallucination, panic attack, restlessness, agitation, aggression, mood swings, apathy.
Renal and urinary disorders: Urinary incontinence, dysuria.
Reproductive system and breast disorders: Erectile dysfunction, sexual dysfunction, delayed ejaculation, dysmenorrhoea, breast pain.
Respiratory, thoracic and mediastinal disorders: Nasopharyngitis, dyspnoea, epistaxis, cough, nasal congestion, rhinitis, snoring, nasal dryness.
Skin and subcutaneous tissue disorders: Rash papular, urticaria, hyperhidrosis, pruritus.
Vascular disorders: Hypotension, hypertension, flushing, peripheral coldness.
Potentially Fatal: Angioedema.

PO: Z (Possible increased risk of major congenital malformation. Avoid unless benefits outweigh risks. If used until delivery, monitor neonate for withdrawal symptoms and toxicity.)

This drug may cause dizziness and somnolence, if affected, do not drive or operate machinery.

Monitor for signs of suicidal ideation and behaviour.

Symptoms: Somnolence, confusional state, agitation, restlessness, and seizures. Rarely, coma. Management: Symptomatic and supportive treatment. May be removed by haemodialysis. Consider administration of activated charcoal if ingestion is within 1 hour.

Additive CNS depressant effects with opiates (e.g. oxycodone) and benzodiazepines (e.g. lorazepam). May increase risk of angioedema with ACE inhibitors.

May enhance CNS depressant effects of alcohol.

Description: Pregabalin is an analog of the neurotransmitter GABA. It binds potently to the α₂-δ subunit resulting in modulation of Ca channels and reduction in the release of several neurotransmitters, including glutamate, norepinephrine, serotonin, dopamine, calcitonin gene-related peptide and substance P.
Onset: Pain management: Noticeable effects on first 7 days of therapy.
Pharmacokinetics:
Absorption: Rapidly absorbed. Bioavailability: ≥90%. Time to peak plasma concentration: Within 1.5 hours.
Distribution: Volume of distribution: 0.5L/kg. Not bound to plasma protein.
Metabolism: Negligible metabolism.
Excretion: Mainly via urine (approx 98% as unchanged, minor metabolites). Half-life: Approx 6.3 hours.

Source: National Center for Biotechnology Information. PubChem Database. Pregabalin, CID=5486971, https://pubchem.ncbi.nlm.nih.gov/compound/Pregabalin (accessed on Jan. 23, 2020)

Store between 15-30°C.

Drugs for Neuropathic Pain

N03AX16 - pregabalin ; Belongs to the class of other antiepileptics.

Anon. Pregabalin. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 03/05/2019.

Anon. Pregabalin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 03/05/2019.

Buckingham R (ed). Pregabalin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/05/2019.

Joint Formulary Committee. Pregabalin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/05/2019.

Lyrica Capsule (Remedyrepack Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 03/05/2019.