Lyrica (pregabalin) is a prescription medication specifically formulated for the management of neuropathic pain and certain seizure disorders. As a potent analog of the neurotransmitter GABA, it modulates calcium channels in the central nervous system to reduce the hyperexcitability of neurons that underlies chronic pain signals and epileptic activity. Its well-established efficacy profile and predictable pharmacokinetics make it a cornerstone in neurological and pain management therapeutic regimens. This product card provides a comprehensive, expert-level overview for healthcare professionals considering its application in clinical practice.

Features

• Active pharmaceutical ingredient: Pregabalin
• Available in oral capsule formulations: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg
• Mechanism of action: Binds to the alpha2-delta subunit of voltage-gated calcium channels in the CNS
• Rapid absorption with peak plasma concentrations achieved within 1.5 hours post-administration
• Linear pharmacokinetics with dose-proportional increases in exposure
• Primarily excreted renally unchanged, with an elimination half-life of approximately 6.3 hours
• Schedule V controlled substance classification in many jurisdictions due to potential for misuse

Benefits

• Provides significant reduction in neuropathic pain scores across multiple etiologies, including diabetic peripheral neuropathy and postherpetic neuralgia
• Demonstrated efficacy as adjunctive therapy for partial-onset seizures in adults, reducing seizure frequency
• Effective management of fibromyalgia pain, improving overall patient function and quality of life
• Rapid onset of action with many patients reporting pain relief within the first week of treatment
• Linear pharmacokinetics allow for predictable dose-response relationships and straightforward titration
• Generally well-tolerated side effect profile when appropriately titrated and monitored

Common use

Lyrica is primarily indicated for the management of neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, and spinal cord injury. It is also approved as adjunctive therapy for adults with partial-onset seizures and for the management of fibromyalgia. Off-label uses include generalized anxiety disorder, restless legs syndrome, and certain types of chronic musculoskeletal pain, though these applications require careful risk-benefit assessment by prescribing clinicians.

Dosage and direction

Initiate treatment at 150 mg daily, administered in two or three divided doses (75 mg twice daily or 50 mg three times daily). Based on individual patient response and tolerability, the dose may be increased to 300 mg daily within one week. For patients requiring additional pain control, the dose may be further increased to a maximum of 600 mg daily after 2-4 weeks of therapy. For seizure disorders, the maximum recommended dose is 600 mg daily. Dosage adjustment is required in patients with renal impairment: CrCl 30-60 mL/min: maximum 300 mg daily; CrCl 15-30 mL/min: maximum 150 mg daily; CrCl <15 mL/min: maximum 75 mg daily. Administration should occur with or without food, but consistency in administration relative to meals is recommended to maintain stable pharmacokinetics.

Precautions

Patients should be cautioned about potential dizziness and somnolence, which may impair their ability to perform hazardous activities such as driving or operating machinery. Gradual dose titration is recommended to minimize these effects. Abrupt discontinuation may precipitate withdrawal symptoms including insomnia, headache, nausea, anxiety, and hyperhidrosis; therefore, tapering over at least one week is advised. Regular monitoring of renal function is essential, particularly in elderly patients or those with comorbid conditions affecting renal clearance. Weight gain has been observed in clinical trials, necessitating periodic weight monitoring and dietary counseling. Patients with a history of substance abuse should be closely monitored due to the drug’s potential for misuse and psychological dependence.

Contraindications

Lyrica is contraindicated in patients with known hypersensitivity to pregabalin or any component of the formulation. Its use is also contraindicated in patients with severe renal impairment (CrCl <15 mL/min) not undergoing hemodialysis, unless dose is appropriately adjusted. Concomitant use with thiazolidinedione antidiabetic agents is contraindicated due to increased risk of peripheral edema and weight gain. The medication is contraindicated in patients with a history of angioedema to previous pregabalin exposure.

Possible side effect

The most commonly reported adverse reactions (≥5% and twice placebo rate) include dizziness (29%), somnolence (22%), dry mouth (11%), peripheral edema (11%), blurred vision (8%), weight gain (7%), and difficulty with concentration/attention (6%). Less frequent but clinically significant side effects include angioedema, euphoria, thrombocytopenia, and creatine kinase elevation. Psychiatric adverse reactions including suicidal ideation and behavior have been reported in approximately 0.2% of patients. Most adverse reactions are dose-dependent and tend to be more pronounced during the titration phase.

Drug interaction

Pregabalin demonstrates minimal metabolic drug interactions as it is not metabolized by and does not inhibit or induce cytochrome P450 enzymes. However, pharmacodynamic interactions occur with CNS depressants including opioids, benzodiazepines, barbiturates, and alcohol, potentially enhancing sedative effects. Concomitant use with thiazolidinediones may exacerbate fluid retention and weight gain. Additive effects on cognitive and motor function may occur when administered with other drugs affecting these systems. Pregabalin may reduce the efficacy of oral contraceptives containing norethindrone, though clinical significance remains uncertain.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is接近 time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent timing of doses is important to maintain stable plasma concentrations, particularly for seizure control.

Overdose

Symptoms of overdose may include profound sedation, confusion, restlessness, agitation, depression, and seizures. Management involves supportive care with maintenance of adequate ventilation, perfusion, and vital sign monitoring. Hemodialysis significantly removes pregabalin (approximately 50% reduction over 4 hours) and should be considered in cases of significant overdose, particularly in patients with renal impairment. There is no specific antidote for pregabalin overdose. Gastric lavage may be considered if presentation occurs within 1-2 hours of ingestion.

Storage

Store at room temperature (20-25°C or 68-77°F) with excursions permitted between 15-30°C (59-86°F). Keep in the original container with the lid tightly closed to protect from moisture. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Protect from light and excessive humidity.

Disclaimer

This information is intended for healthcare professionals and should not replace clinical judgment. Prescribing decisions must be based on the individual patient’s medical history, current medications, and specific clinical circumstances. The full prescribing information should be consulted before initiating therapy. Patients should be advised to read the medication guide provided with their prescription and to discuss any questions with their healthcare provider.

Reviews

Clinical trials demonstrate that 60-70% of patients with diabetic neuropathy achieve ≥50% pain relief with pregabalin compared to 30-40% with placebo. In fibromyalgia studies, patients reported significant improvements in pain scores, sleep quality, and overall function. Neurologists frequently report satisfactory seizure control when used as adjunctive therapy. The most common criticisms in post-marketing surveillance relate to CNS side effects during titration and weight gain with long-term use. Overall, the medical community regards pregabalin as a valuable therapeutic option when appropriately selected and monitored.