What is the use of Lyrica (Pregabalin)?

From the Guidelines

Lyrica (pregabalin) is recommended as a first-line treatment for neuropathic pain, with a typical starting dose of 50mg three times daily or 75mg twice daily, which can be increased gradually to 300-600mg daily divided into two or three doses based on response and tolerability 1.

Key Points to Consider

• Pregabalin works by binding to calcium channels in the nervous system, reducing the release of excitatory neurotransmitters that cause pain and seizures.
• Common side effects include dizziness, drowsiness, dry mouth, and weight gain.
• Patients should take Lyrica with or without food, avoid abrupt discontinuation (which can cause withdrawal symptoms), and be aware that it may impair driving ability.
• Those with kidney impairment typically require dose adjustments, as pregabalin is renally excreted and its dosage should be reduced in patients with renal insufficiency 1.
• Lyrica has potential for dependence, so it's classified as a controlled substance in many countries, and patients should inform their doctor of all other medications they're taking to avoid interactions.

Dosage and Administration

• The dosage of pregabalin can be titrated up to 300 mg/d after 1 or 2 weeks, and for patients who tolerate 300 mg/d but have inadequate pain relief, the dosage can be further titrated to 600 mg/d 1.
• However, higher dosages are not consistently more effective than 300 mg/d and are associated with a greater rate of adverse effects.

Efficacy and Safety

• Pregabalin has been shown to be highly effective in the treatment of painful diabetic peripheral neuropathy in several randomized controlled trials, with a number needed to treat (NNT) of 4.04 for 600 mg/day and 5.99 for 300 mg/day 1.
• The most frequent side effects for pregabalin are dizziness, somnolence, peripheral oedema, headache, and weight gain.

Clinical Considerations

• Pregabalin may provide analgesia more quickly than gabapentin because the initial dosage of 150 mg/d has been found to be efficacious in some trials, and the time required to titrate to a full dosage is less 1.
• Patients with cardiac disease should be cautious when taking pregabalin, as it may cause cardiovascular effects, although the evidence is limited 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Overview of Lyrica (Pregabalin)

• Lyrica, also known as pregabalin, is a medication used to treat neuropathic pain and fibromyalgia 2, 3, 4, 5, 6
• It is an antiepileptic drug that has been shown to be effective in reducing pain intensity and improving quality of life in patients with neuropathic pain conditions 2, 3, 6

Efficacy of Lyrica

• Studies have shown that Lyrica is effective in treating painful diabetic neuropathy, postherpetic neuralgia, and central neuropathic pain 2, 3, 6
• It has also been shown to be effective in treating fibromyalgia, with improvements in pain intensity and quality of life 2, 6
• A meta-analysis of 14 studies found that Lyrica showed superior results compared to gabapentin in reducing pain intensity and improving patient-reported outcomes 6

Comparison to Gabapentin

• Gabapentin and Lyrica are both antiepileptic drugs used to treat neuropathic pain, but they have different pharmacokinetic profiles and efficacy 3, 4, 5, 6
• A retrospective cohort study found that there was no significant difference in meaningful pain reduction between gabapentin and Lyrica, but Lyrica may afford better tolerability and lower pill burden 5
• A meta-analysis found that Lyrica demonstrated superior and faster efficacy in alleviating neuropathic pain than gabapentin, with improvements in patient-reported outcomes and lower opioid consumption 6

Safety and Adverse Events

• Lyrica has been associated with adverse events such as dizziness, somnolence, and nausea 3, 6
• A meta-analysis found that Lyrica resulted in fewer adverse events compared to gabapentin, with a lower incidence of nausea and vomiting 6
• The risk of serious adverse events with Lyrica is low, but it is a Schedule V controlled substance and its use should be carefully monitored, particularly in patients with a history of substance abuse 3