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pregabalin capsules CV
Pharmacologic class: Miscellaneous anticonvulsant
Therapeutic class: Anticonvulsant
Pregnancy risk category C
Unclear. Binds with high affinity to CNS alpha2-delta site (auxiliary subunit of voltage-gated calcium channels), possibly resulting in antinociceptive and antiseizure effects.
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.
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.
• Renal impairment
• Hypersensitivity to drug or its components
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).
• 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.
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)
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
☞ 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.
• 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.
Pharmacologic: gamma aminobutyric acid gaba analogues
Time/action profile (↓ post–herpetic pain)
Adverse Reactions/Side Effects
Central nervous system
- suicidal thoughts (life-threatening)
- dizziness (most frequent)
- drowsiness (most frequent)
- impaired attention/concentration/thinking
- edema (most frequent)
Ear, Eye, Nose, Throat
- blurred vision
- dry mouth (most frequent)
- abdominal pain
- ↑ appetite
- weight gain
- allergic reactions
Drug-Drug interactionConcurrent 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.
Diabetic Neuropathic Pain
Spinal Cord Injury Neuropathic Pain
Partial Onset Seizures
Renal ImpairmentOral (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)
- 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 DiagnosesRisk for injury (Adverse Reactions)
- 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.
- 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.
- Decrease in intensity of chronic pain.
- Decrease in the frequency or cessation of seizures.
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!
there is a moderate interaction. that means you can take them both but be checked regularly for depression of breath.
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