Pregabalin Use in 18-Year-Old Patients
Pregabalin is safe and appropriate to use in 18-year-old patients, as they are considered adults for medication dosing purposes and fall within the FDA-approved age range for this medication. 1
FDA Approval and Age Considerations
Pregabalin (Lyrica) is FDA-approved for use in adults 18 years of age and older for several conditions including:
- Neuropathic pain associated with diabetic peripheral neuropathy
- Postherpetic neuralgia
- Fibromyalgia
- Neuropathic pain following spinal cord injury 1
For seizure disorders, pregabalin is approved for patients as young as 1 month of age when used as adjunctive therapy for partial-onset seizures 1.
Dosing Considerations for Young Adults
When prescribing pregabalin to an 18-year-old patient:
- Start with the lowest effective dose (typically 75-150 mg/day divided into 2-3 doses) 2
- Titrate gradually based on response and tolerability
- The effective dose range is typically 150-600 mg/day, with most patients responding to 300-450 mg/day 3
- For neuropathic pain conditions, 150 mg/day is often ineffective, while doses of 300 mg, 450 mg, and 600 mg daily have demonstrated efficacy 3
Safety Profile in Young Adults
Pregabalin has a favorable safety profile in adults, including young adults:
- Linear pharmacokinetics with approximately 90% oral bioavailability 4
- Not metabolized by the liver (minimal drug interactions)
- Primarily excreted unchanged through the kidneys (95%) 4
- No dose adjustment needed in patients with normal renal function 5
Common Side Effects to Monitor
The most common adverse effects to monitor in an 18-year-old patient include:
- Dizziness (occurring in 27-46% of patients at 600 mg/day)
- Somnolence (15-25% of patients at 600 mg/day)
- Peripheral edema
- Dry mouth
- Weight gain 3, 5
These side effects are dose-dependent but not age-dependent in adult populations 5.
Important Precautions
When prescribing pregabalin to an 18-year-old, be aware of these important precautions:
- Monitor for mood changes or suicidal thoughts (boxed warning for all antiepileptic drugs) 1
- Assess for potential substance abuse risk factors (pregabalin has abuse potential) 6
- Avoid abrupt discontinuation (taper gradually to prevent withdrawal symptoms) 1
- Counsel regarding avoiding alcohol and other CNS depressants while taking pregabalin 1
- Advise against driving or operating machinery until effects on alertness are known 1
Abuse Potential Considerations
Young adults may be at higher risk for pregabalin misuse:
- Approximately 9.6% of pregabalin users in a large study received doses exceeding 600 mg/day for 6 months 6
- Male gender and concurrent use of benzodiazepines or antipsychotics were associated with higher risk of exceeding recommended dosages 6
- Consider more frequent follow-up and prescription monitoring in patients with risk factors for substance abuse
Conclusion
Pregabalin is an appropriate and safe medication option for 18-year-old patients when prescribed for approved indications, with proper dosing, and with appropriate monitoring for side effects and abuse potential.