- Anticonvulsant
- Adjunct for partial-onset Seizures
- Neuropathic Pain Management
- Lipophilic (greater diffusion across blood brain barrier)
- Binds alpha2-delta1 subunit of Central Nervous System voltage-gated Calcium channels
- GABA Receptor Agonist, but does not bind GABA Receptors or Benzodiazepine receptors
- Adults - Chronic Neuropathic Pain (Diabetic Neuropathy, Postherpetic Neuralgia, Fibromyalgia)
- Regular Release
- Start 50 mg orally three times daily or 75 mg orally twice daily
- May start at 25 mg orally three times daily to maximize tolerability
- May increase after 1 week to 100 mg orally three times daily or 150 mg orally twice daily
- Maximum dose: 300 mg (Diabetic Neuropathy), 450 mg (Fibromyalgia), 600 mg/day (Postherpetic Neuralgia)
- Start 50 mg orally three times daily or 75 mg orally twice daily
- Extended Release (Pregabalin XR, Lyrica CR)
- Stopping
- Taper off agent over 1 week or more
- Avoid stopping abruptly due to withdrawal symptoms
- Adult
- Start 50 mg orally three times daily or 75 mg orally twice daily
- Maximum: 600 mg/day
- Child (over age 1 month)
- Weight > 30 kg
- Start 2.5 mg/kg/day divided 2-3 times per day
- Titrate as needed to 10 mg/kg/day in divided doses (maximum 600 mg/day)
- Weight <30 kg
- Start 3.5 mg/kg/day divided 3 times per day
- Titrate as needed to 14 mg/kg/day in divided doses (maximum 600 mg/day)
- Weight > 30 kg
- Decrease Pregabalin dosing in Creatinine Clearance <60 ml/min
- Unknown Safety in Lactation
- First trimester use linked to possible birth defects
- Common adverse effects
- Severe but uncommon adverse effects
- Other adverse effects
- Risk of Abuse
- Gabapentin and Pregabalin (Lyrica) are abused by patients on Opiates to potentiate CNS Opiate effects
- More than one quarter of Opiate patients have abused Gabapentin
- Pregabalin (Lyrica) is more potent with faster onset and has higher abuse potential than Gabapentin
- Smith (2012) Br J Gen Pract 62(601):406-7 +PMID:22867659 [PubMed]
- Cardiovascular Events
- Single retrospective EHR chart review associated Gabapentin and Pregabalin with cardiovascular events
- Higher quality confirmatory studies are needed
- Pan (2022) Cardiovasc Diabetol 21(1):170 +PMID: 36050764 [PubMed]
- (2022) Presc Lett, Resource #361206, Antiseizure Medications
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 56-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia