Indications for Lyrica (Pregabalin) Use
Lyrica (pregabalin) is FDA-approved for five specific indications: management of neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, fibromyalgia, neuropathic pain associated with spinal cord injury, and as adjunctive therapy for partial-onset seizures in patients 1 month of age and older. 1
Primary Indications
Neuropathic Pain Conditions
- Diabetic peripheral neuropathy: First-line therapy for painful diabetic neuropathy 2, 1
- Postherpetic neuralgia: First-line therapy 2, 1
- Spinal cord injury-related neuropathic pain: FDA-approved indication 1
Fibromyalgia
- FDA-approved for management of fibromyalgia 2, 1
- Associated with small to moderate improvements in pain, function, and quality of life in fibromyalgia patients 2
Epilepsy
- Adjunctive therapy for partial-onset seizures in patients 1 month of age and older 1
Dosing Considerations
General Dosing
- Starting dose: 25-50 mg/day in older adults or those with renal impairment 2
- Effective dose range: 150-600 mg/day in two divided doses 2
- Titration: Gradual dose escalation until benefit occurs or side effects appear 2
Renal Adjustment
Dose must be reduced in patients with renal impairment:
- CrCl ≥60 mL/min: Standard dosing
- CrCl 30-59 mL/min: Reduced dosing
- CrCl 15-29 mL/min: Further reduced dosing
- CrCl ≤15 mL/min: Minimal dosing 3
Special Populations and Considerations
Elderly Patients
- Lower starting doses (25-50 mg/day) recommended 2
- Increased risk of adverse effects including somnolence, dizziness, and mental clouding 2
- Effective doses may be lower than in younger adults 2
Monitoring Requirements
- Regular evaluation every 2-4 weeks during medication titration 3
- Assessment of pain relief, function, and adverse effects 3
- Full therapeutic trial requires 2 months before determining effectiveness 3
Potential for Misuse
- Designated as Schedule V controlled substance due to potential for abuse 4
- Risk factors for use above recommended dosage include male gender and concurrent use of antipsychotics or benzodiazepines 5
- Approximately 9.6% of users may take doses exceeding 600 mg/day 5
Adverse Effects
- Most common: dizziness and somnolence 4, 6
- Also reported: weight gain, peripheral edema (especially in elderly) 7
- Visual field restriction has been reported in clinical trials 7
- Should not be discontinued rapidly 6
Comparative Efficacy
- Similar mechanism and efficacy to gabapentin but with more predictable pharmacokinetics 7, 8
- Linear pharmacokinetics with high oral bioavailability (90%) 8
- Minimal drug interactions due to lack of hepatic metabolism 4
When selecting pregabalin, consider the specific indication, renal function, age, and potential for adverse effects. For neuropathic pain conditions, pregabalin may be used as first-line therapy or after failure of other agents such as tricyclic antidepressants.