From the FDA Drug Label
- 7 Dosing for Adult Patients with Renal Impairment In view of dose-dependent adverse reactions and since pregabalin is eliminated primarily by renal excretion, adjust the dose in adult patients with reduced renal function. Base the dose adjustment in patients with renal impairment on creatinine clearance (CLcr), as indicated in Table 2.
The use of pregabalin (Lyrica) in patients with Acute Kidney Injury (AKI) is not directly addressed in the provided drug label. However, it does provide guidance on dosing adjustments for adult patients with renal impairment.
- Pregabalin dose adjustment is based on creatinine clearance (CLcr).
- The label provides a table (Table 2) to determine the corresponding renal adjusted dose.
- For patients undergoing hemodialysis, the label recommends adjusting the pregabalin daily dose based on renal function and administering a supplemental dose immediately following every 4-hour hemodialysis treatment. Since AKI is a condition characterized by a rapid decline in renal function, it is essential to exercise caution when using pregabalin in these patients. Given the information provided, it is recommended to adjust the dose of pregabalin based on the patient's renal function, as indicated in Table 2, and to monitor renal function closely 1.
From the Research
Lyrica (pregabalin) can be used in patients with acute kidney injury (AKI), but it requires careful dose adjustment and monitoring due to its renal elimination and potential for accumulation and toxicity in impaired kidney function. The decision to use Lyrica in AKI should prioritize the patient's overall clinical condition, the severity of AKI, and the potential benefits versus risks of the medication.
Key Considerations for Using Lyrica in AKI
- Dose adjustment is crucial because pregabalin is primarily eliminated unchanged through the kidneys 2.
- In AKI, the standard dosage should be reduced based on the patient's creatinine clearance or estimated glomerular filtration rate.
- For mild to moderate AKI, a 25-50% dose reduction is typically recommended, while in severe AKI, the dose may need to be reduced by 50-75% or potentially avoided altogether depending on the clinical situation.
- The dosing interval may also need to be extended to prevent accumulation and minimize the risk of adverse effects.
Monitoring and Adjustment
Regular monitoring of kidney function and assessment for adverse effects such as dizziness, somnolence, peripheral edema, and confusion is essential when using pregabalin in patients with AKI 2. If the patient's kidney function improves, the dosage can be gradually adjusted accordingly under medical supervision. It's also important to consider the latest evidence suggesting that pregabalin may have a more favorable profile compared to gabapentin in terms of renal outcomes in certain contexts 2.
Clinical Decision-Making
The use of Lyrica in AKI should be individualized, taking into account the specific clinical scenario, the severity of kidney injury, and the presence of other comorbid conditions. Given the potential for renal function to fluctuate, close monitoring and a readiness to adjust the treatment plan as necessary are critical components of managing patients with AKI who are receiving Lyrica.