Can you take Lyrica (pregabalin) with chronic kidney disease (CKD)?

Pregabalin (Lyrica) Use in Chronic Kidney Disease

Pregabalin can be taken with chronic kidney disease, but dose adjustment is required based on kidney function, with significant dose reductions needed as GFR decreases below 60 mL/min/1.73m². 1

Dosing Recommendations Based on Kidney Function

Pregabalin is primarily eliminated by renal excretion, making dose adjustment essential in CKD patients. The FDA-approved labeling specifically addresses renal impairment:

• Normal kidney function: Standard dosing
• eGFR 30-60 mL/min/1.73m²: Reduce daily dose by 50%
• eGFR 15-30 mL/min/1.73m²: Reduce daily dose by 75%
• eGFR <15 mL/min/1.73m²: Further reduction needed
• Hemodialysis patients: Supplemental dose required after each dialysis session

Pharmacokinetic Considerations

Pregabalin's pharmacokinetics are significantly altered in CKD:

• Total and renal clearance of pregabalin are proportional to creatinine clearance 2
• Area under the curve (AUC) and elimination half-life increase as kidney function declines
• Without dose adjustment, drug accumulation can occur, increasing risk of adverse effects

Monitoring Requirements

When prescribing pregabalin to CKD patients:

• Monitor eGFR regularly (at least every 3-6 months in advanced CKD)
• Watch for signs of toxicity including:
  • Excessive sedation
  • Dizziness
  • Peripheral edema
  • Confusion
  • Balance disorders (especially in elderly patients)

Clinical Considerations

1. Benefit vs. Risk Assessment:

   • Consider if pregabalin is the most appropriate option for the indication
   • Weigh potential benefits against risks in advanced CKD

2. Common Pitfalls to Avoid:

   • Failing to adjust dose based on kidney function
   • Not reassessing kidney function regularly
   • Sudden discontinuation (can precipitate seizures in some patients) 3
   • Not providing supplemental dosing after hemodialysis

3. Drug Stewardship in CKD:

   • Perform thorough medication reviews periodically 4
   • Consider potential drug interactions with other medications commonly used in CKD
   • Educate patients about expected benefits and possible risks 4

Alternative Considerations

For neuropathic pain in CKD patients, if pregabalin is not suitable or poorly tolerated, consider:

• Gabapentin (also requires renal dose adjustment)
• Duloxetine (for diabetic neuropathy, with caution in advanced CKD)
• Tricyclic antidepressants (with careful monitoring)

Summary

Pregabalin can be used in CKD patients with appropriate dose adjustments based on kidney function. The key is to start with lower doses, adjust based on eGFR, monitor kidney function regularly, and watch for adverse effects. Supplemental dosing after hemodialysis is necessary for patients on dialysis.