What are the contraindications for Lyrica (pregabalin)?

Contraindications for Lyrica (Pregabalin)

Lyrica (pregabalin) is contraindicated in patients with known hypersensitivity to pregabalin or any of its components, as this can lead to angioedema and serious hypersensitivity reactions. 1

Primary Contraindication

• Hypersensitivity: The FDA drug label clearly states that pregabalin is contraindicated in patients with known hypersensitivity to the drug or any of its components, as this can trigger potentially dangerous reactions including angioedema 1.

Special Populations and Precautions

While not absolute contraindications, the following represent important precautions and relative contraindications:

Renal Impairment

• Pregabalin is eliminated primarily through renal excretion (98% unchanged) 2
• Dose adjustment is necessary in patients with:
  • Moderate renal insufficiency (creatinine clearance below 60 ml/min) 3
  • Severe renal impairment

History of Substance Abuse

• Caution is warranted in patients with current or past substance-related disorders
• Pregabalin has potential to trigger addictive behaviors 4
• Cases of pregabalin abuse with euphoric effects and withdrawal symptoms have been reported 4

Pregnancy

• Pregabalin should be avoided in patients who are or may become pregnant
• Women of reproductive potential should use reliable contraception methods 5

Cardiovascular Concerns

• Use with caution in patients with heart failure or peripheral edema
• Pregabalin can cause peripheral edema (10.4% of patients), particularly in elderly patients 2, 3

Visual Field Defects

• Cases of visual field restriction have been reported in clinical trials 3
• Consider ophthalmologic monitoring in long-term use

Common Adverse Effects to Consider

While not contraindications, the following common adverse effects may influence prescribing decisions:

• Neurological effects: Dizziness (23.1%) and somnolence/drowsiness (14.6%) 2
• Weight gain: Similar to gabapentin 3
• Peripheral edema: Occurs in approximately 10.4% of patients 2

Practical Prescribing Algorithm

1. Screen for absolute contraindication: Known hypersensitivity to pregabalin or its components
2. Assess renal function: Adjust dose if creatinine clearance <60 ml/min
3. Evaluate risk factors:
   • History of substance abuse
   • Pregnancy or potential for pregnancy
   • Cardiovascular disease or edema
   • Visual field defects
4. Consider starting dose: 150 mg/day divided in 2-3 doses for neuropathic pain 2
5. Monitor for adverse effects: Particularly dizziness, somnolence, and peripheral edema

By carefully screening for contraindications and considering these precautions, clinicians can optimize the safety profile of pregabalin therapy while maintaining its effectiveness for approved indications.