From the Research
Lyrica (pregabalin) should be used with caution in patients with mitochondrial deficiency, and is generally not considered a first-line treatment for these patients. While there is no absolute contraindication, pregabalin can potentially worsen mitochondrial function by affecting cellular energy production 1. Patients with mitochondrial disorders often have compromised energy metabolism, and medications that further stress these pathways may exacerbate symptoms or trigger decompensation.
Key Considerations
- If Lyrica must be used for conditions like neuropathic pain in these patients, it should be started at lower doses (such as 25-50mg twice daily) with very gradual titration while closely monitoring for adverse effects.
- Particular attention should be paid to symptoms like increased fatigue, muscle weakness, or cognitive changes, which could indicate worsening mitochondrial function.
- Alternative pain medications with better-established safety profiles in mitochondrial disease, such as certain antidepressants or topical agents, may be preferable.
- The decision to use pregabalin should involve weighing the potential benefits against risks, ideally in consultation with a specialist familiar with mitochondrial disorders.
Pharmacokinetics and Dosing
- Pregabalin is rapidly absorbed following oral administration, with peak plasma concentrations occurring between 0.7 and 1.3 hours 2.
- Pregabalin oral bioavailability is approximately 90% and is independent of dose and frequency of administration 2.
- Pregabalin elimination half-life is approximately 6 hours and steady state is achieved within 1 to 2 days of repeated administration 2.
- Corrected for oral bioavailability, pregabalin plasma clearance is essentially equivalent to renal clearance, indicating that pregabalin undergoes negligible nonrenal elimination 2.
- Pregabalin dosage adjustment should be considered for patients with decreased renal function, with a 50% reduction in pregabalin daily dose recommended for patients with creatinine clearance between 30 and 60 mL/min compared to those with creatinine clearance > 60 mL/min 3.