Lyrica


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pregabalin capsules CV

Lyrica

Pharmacologic class: Miscellaneous anticonvulsant

Therapeutic class: Anticonvulsant

Pregnancy risk category C

Action

Unclear. Binds with high affinity to CNS alpha2-delta site (auxiliary subunit of voltage-gated calcium channels), possibly resulting in antinociceptive and antiseizure effects.

Availability

Capsules: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg

Indications and dosages

Adjunct for partial-onset seizures in adults

Adults: Initially, 75 mg P.O. b.i.d. or 50 mg P.O. t.i.d.; may increase to maximum of 600 mg P.O. daily given in divided doses based on response and tolerance

Neuropathic pain related to diabetic peripheral neuropathy

Adults: Initially, 50 mg P.O. t.i.d. in patients with creatinine clearance of at least 60 ml/minute; may increase to maximum of 100 mg P.O. t.i.d. within 1 week based on efficacy and tolerance

Postherpetic neuralgia

Adults: Initially, 75 mg P.O. b.i.d., or 50 mg P.O. t.i.d. in patients with creatinine clearance of at least 60 ml/minute; may increase to maximum of 300 mg P.O. daily within 1 week based on efficacy and tolerance. Tolerant patients who don't obtain sufficient pain relief after 2 to 4 weeks of 300 mg daily may receive up to 300 mg b.i.d. or 200 mg t.i.d. Reserve dosages above 300 mg daily for patients with ongoing pain who tolerate 300 mg daily.

Fibromyalgia

Adults: Initially, 75 mg P.O. b.i.d. in patients with creatinine clearance of at least 60 ml/minute; may increase to 150 mg P.O. b.i.d. within 1 week based on efficacy and tolerance. If patient doesn't obtain sufficient benefit at 300 mg daily, dosage may be increased further to 225 mg b.i.d. Dosages above 450 mg daily aren't recommended.

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:
• abnormal creatinine clearance
• concurrent use of thiazolidinedione antidiabetics
• history of angioedema episode
• concurrent use of drugs associated with angioedema (such as angiotensin-converting enzyme inhibitors)
• elderly patients
• children (safety and efficacy not established).

Administration

• Give with or without food.
• To discontinue drug, withdraw gradually over at least 1 week to reduce risk of increased seizure frequency in patients with history of seizure disorders.

Adverse reactions

CNS: dizziness, somnolence, euphoria, balance disorder, abnormal thinking, asthenia, neuropathy, ataxia, vertigo, confusion, incoordination, abnormal gait, tremor, amnesia, nervousness, headache, speech disorder, twitching, myoclonus, fatigue, feeling drunk, hypertonia, hypoesthesia, paresthesia, lethargy, anxiety, disorientation, depression, depersonalization, stupor

EENT: abnormal or blurred vision, diplopia, nystagmus, conjunctivitis, sinusitis, otitis media, tinnitus, pharyngolaryngeal pain

GI: vomiting, constipation, flatulence, abdominal distention, gastroenteritis, dry mouth

GU: urinary incontinence, urinary frequency, decreased libido, anorgasmia, erectile dysfunction

Metabolic: hypoglycemia, fluid retention

Musculoskeletal: back pain, myasthenia, arthralgia, muscle spasms

Respiratory: dyspnea, bronchitis

Skin: ecchymosis, pruritus

Other: increased appetite, weight gain, edema, peripheral edema, accidental injury, pain, chest pain, infection, allergic reaction, angioedema, hypersensitivity reactions including anaphylactoid reactions (rare)

Interactions

Drug-drug.Gabapentin: slight decrease in pregabalin rate of absorption

Lorazepam, oxycodone: exacerbated effects on cognitive and gross motor functioning

Drug-diagnostic tests.Serum glucose: decreased level

Drug-behaviors.Alcohol use: exacerbated effects on cognitive and gross motor functioning

Patient monitoring

Monitor patient closely for hypersensitivity reaction and angioedema; if these effects occur, discontinue drug and begin emergency measures immediately.
• Know that patients with history of drug or alcohol abuse may be more likely to misuse or abuse drug.

Patient teaching

• Instruct patient to take drug with or without food.

Teach patient to recognize signs and symptoms of angioedema and to discontinue drug and seek immediate medical care if these arise.

Inform patient that drug may cause hypersensitivity reactions, such as wheezing, dyspnea, rash, hives, and blisters. Advise patient to discontinue drug and seek medical care if these reactions occur.
• Inform patient that drug may cause weight gain and edema.
• Advise patient to avoid driving and other hazardous activities until drug's effects on vision and alertness are known.
• Caution patient to avoid alcohol while taking drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

pregabalin

(pre-gab-a-lin) ,

Lyrica

(trade name)

Classification

Therapeutic: analgesics
Pharmacologic: gamma aminobutyric acid gaba analogues
Pregnancy Category: C

Indications

Neuropathic pain associated with diabetic peripheral neuropathyPostherpetic neuralgiaFibromyalgiaNeuropathic pain associated with spinal cord injuryAdjunctive therapy of partial-onset seizures in adults.

Action

Binds to calcium channels in CNS tissues which regulate neurotransmitter release. Does not bind to opioid receptors.

Therapeutic effects

Decreased neuropathic or post-herpetic pain.
Decreased partial-onset seizures.

Pharmacokinetics

Absorption: Well absorbed (90%) following oral administration.
Distribution: Probably crosses the blood-brain barrier.
Metabolism and Excretion: Minimally metabolized, 90% excreted unchanged in urine.
Half-life: 6 hr.

Time/action profile (↓ post–herpetic pain)

ROUTEONSETPEAKDURATION
POunknown2–4 wkunknown

Contraindications/Precautions

Contraindicated in: Myopathy (known/suspected); Lactation: Lactation.
Use Cautiously in: All patients (may ↑ risk of suicidal thoughts/behaviors);Renal impairment (dose alteration recommended for CCr <60 mL/min);HF;History of drug dependence/drug-seeking behavior; Obstetric: Use only if maternal benefit outweighs fetal risk; may ↑ risk of male-mediated teratogenicity; Pediatric: Safety not established; Geriatric: Consider age-related ↓ in renal function when determining dose.

Adverse Reactions/Side Effects

Central nervous system

  • suicidal thoughts (life-threatening)
  • dizziness (most frequent)
  • drowsiness (most frequent)
  • impaired attention/concentration/thinking

Cardiovascular

  • edema (most frequent)

Ear, Eye, Nose, Throat

  • blurred vision

Gastrointestinal

  • dry mouth (most frequent)
  • abdominal pain
  • constipation
  • ↑ appetite
  • vomiting

Hematologic

  • thrombocytopenia

Metabolic

  • weight gain

Miscellaneous

  • allergic reactions
  • fever

Interactions

Drug-Drug interaction

Concurrent use with thiazolidinediones (pioglitazone,rosiglitazone ) may ↑ risk of fluid retention.↑ risk of CNS depression with other CNS depressants including opioids, alcohol, benzodiazepines, or other sedatives/hypnotics.

Route/Dosage

Diabetic Neuropathic Pain

Oral (Adults) 50 mg 3 times daily, ↑ over 7 days up to 100 mg 3 times daily

Postherpetic Neuralgia

Oral (Adults) 75 mg twice daily or 50 mg 3 times daily initially, may be ↑ over 7 days to 300 mg/day in 2–3 divided doses; after 2–4 wk may be ↑ to 600 mg/day in 2–3 divided doses

Fibromyalgia

Oral (Adults) 75 mg twice daily initially, may be ↑ to 150 mg twice daily within 1 wk based on efficacy and tolerability. May be ↑ to 225 twice daily

Spinal Cord Injury Neuropathic Pain

Oral (Adults) 75 mg twice daily initially, may be ↑ to 150 mg twice daily within 1 wk based on efficacy and tolerability; if insufficient pain relief after 2–3 wk, may ↑ to 300 twice daily

Partial Onset Seizures

Oral (Adults) 75 mg twice daily or 50 mg 3 times daily initially; may be gradually ↑ to 600 mg/day

Renal Impairment

Oral (Adults) CCr 30–60 mL/min—75–300 mg/day in 2–3 divided doses; CCr 15–30 mL/min—25–150 mg/day in 1–2 divided doses; CCr < 15 mL/min—25–75 mg/day as a single daily dose

Availability (generic available)

Capsules: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg Cost: 25 mg $411.71 / 100, 50 mg $409.80 / 100, 75 mg $409.80 / 100, 100 mg $409.80 / 100, 150 mg $409.80 / 100, 200 mg $411.71 / 100, 225 mg $411.71 / 100
Oral solution: 20 mg/mL Cost: $553.82 / 473 mL

Nursing implications

Nursing assessment

  • Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.
  • Diabetic Peripheral Neuropathy, Postherpetic Neuralgia, Fibromyalgia, and Spinal Cord Injury Pain: Assess location, characteristics, and intensity of pain periodically during therapy.
  • Seizures: Assess location, duration, and characteristics of seizure activity.
  • Lab Test Considerations: May cause ↑ creatine kinase levels.
    • May cause↓ platelet count.

Potential Nursing Diagnoses

Risk for injury (Adverse Reactions)

Implementation

  • Do not confuse Lyrica (pregabalin) with Lopressor (metoprolol).
  • Pregabalin should be discontinued gradually over at least 1 wk. Abrupt discontinuation may cause insomnia, nausea, headache, anxiety, sweating, and diarrhea when used for pain and may cause increase in seizure frequency when treating seizures.
  • Oral: May be administered without regard to meals. Oral solution may be stored at room temperature.

Patient/Family Teaching

  • Instruct patient to take medication as directed. If a dose is missed take as soon as remembered unless almost time for next dose; do not double doses. Do not discontinue abruptly; may cause insomnia, nausea, headache, or diarrhea or increase in frequency of seizures. Advise patient to read the Patient Information Leaflet prior to taking pregabalin.
  • May cause dizziness, drowsiness, and blurred vision. Caution patient to avoid driving or activities requiring alertness until response to medication is known. Advise patient to notify health care professional if changes in vision occur. Patients with seizures should not resume driving until health care professional gives clearance based on control of seizure disorder.
  • Instruct patient to promptly report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever. Discontinue therapy if myopathy is diagnosed or suspected or if markedly elevated creatine kinase levels occur.
  • Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur.
  • Inform patient that pregabalin may cause edema and weight gain.
  • Caution patient to avoid alcohol or other CNS depressants with pregabalin.
  • Instruct patient to notify health care professional of medication regimen before treatment or surgery.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding. Inform male patients who plan to father a child of the potential risk of male-mediated teratogenicity. Encourage patients who become pregnant to enroll in the NAAED Pregnancy Registry by calling 1–800–233–2334.
  • Advise patient to carry identification describing disease process and medication regimen at all times.

Evaluation/Desired Outcomes

  • Decrease in intensity of chronic pain.
  • Decrease in the frequency or cessation of seizures.

Lyrica

a trademark for pregabalin.

Patient discussion about Lyrica

Q. Had FMS for almost twenty years now, tried almost everything. Is Lyrica in the "steroid" family? Any one in this community could help me? I have given my few questions to find out an answer. I Had FMS for almost twenty years now, tried almost everything. I'm considering Lyrica but I'd like more info. Is Lyrica in the "steroid" family? If you go on Lyrica for a while & see no improvement with pain, is going off of it a big deal like with other med's, or can you simply just stop taking it? I take Ambien, will that have any interactions? I'm seeing my Doc about this at the end of the month, but I was hoping to get some personal experiences about it. Thanks for any thoughts! Thanks for your answers, keep them coming!

A. according to this-
http://www.drugs.com/drug_interactions.php
there is a moderate interaction. that means you can take them both but be checked regularly for depression of breath.

Q. I've a chronic pain website & would love 2 get comments on how 2 make it better http://chronicpain.today.c

A. VIDEOS IS GREAT I WILL THAT N THANKS

More discussions about Lyrica
References in periodicals archive ?
LYRICA is contraindicated in patients with known hypersensitivity to pregabalin or any of its other components.
According to an SCH statement issued yesterday, individuals may only possess Lyrica for personal use and for purely health reasons within the limits of the amount prescribed by a licensed physician.
The study was a randomized, double-blind, parallel-group, multicenter, comparative, flexible-dose study to compare Lyrica (300, 450, 600 mg/day) to levetiracetam (1,000, 2,000, 3,000 mg/day) in reducing partial onset seizure frequency in subjects with epilepsy.
Elsewhere, at St Edmunds Church, FISHBURN BAND will be performing alongside LOL AND MAXINE ALLAN, LYRICA and THE CLEVELAND BRANCH OF THE NORTHUMBRIAN PIPERS.
Other medications like Celebrex, Advil, Motrin, Neurontin, Lyrica and Tegretol are also retention causing medications.
Pfizer sold more than $5 billion in painkillers in 2009 led by Celebrex for arthritis and Lyrica for nerve pain.
Pfizer's $1 billion civil penalty is to resolve civil allegations of illegally promoting three other drugs in addition to Bextra drugs--Geodon, an anti-psychotic drug; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug.
Patients with fibromyalgia often respond to aerobic exercise with a dramatic decrease in pain, and the use of Lyrica, Cymbalta, or milnacipran should be instituted prior to resorting to opioids in these patients.
Specific drugs are discussed, including Lipitor, Lyrica, and Zoloft.
However, Lyrica is an effective medication on an international scale and has been approved by the American Food and Drug Administration," she said, noting that the conference also discussed a variety of other common illnesses related to diabetes, such as heart and eye diseases.
Growth over the past four years has been driven largely by the successful launch of Lyrica (pregabalin) for diabetic neuropathic pain and post-herpetic neuralgia in December 2004 along with its 2007 approval for fibromyalgia, as well as the launch of Lilly's Cymbalta (duloxetine) for diabetic neuropathic pain in 2004.
Until Lyrica was approved for fibromyalgia last July, no medication officially had been tested or approved by the U.