Contraindications for Pregabalin (Lyrica)
Pregabalin is contraindicated in patients with known hypersensitivity to pregabalin or any of its components, as angioedema and hypersensitivity reactions have occurred in patients receiving pregabalin therapy. 1
Absolute Contraindications
- Hypersensitivity to pregabalin or any component of the formulation - This is the only absolute contraindication listed in the FDA label 1
Relative Contraindications and Special Precautions
Renal Impairment
- Pregabalin is primarily excreted unchanged by the kidneys (>98% of the drug) 2
- Dose adjustment is required for patients with renal insufficiency 3, 4
- Failure to adjust dosage in renal impairment can lead to drug accumulation and increased side effects 2
Concomitant Use Considerations
- Use with caution in patients taking opioids due to potential for additive central nervous system depression 5
- Contraindicated for use with monoamine oxidase inhibitors (MAOIs) 5
- Use with caution in patients on chronic opioid therapy 5
Cardiovascular Considerations
- Use with caution in patients with heart failure or peripheral edema 3
- Peripheral edema is a common side effect (approximately 10% of patients) 3
Neurological Considerations
- Use with caution in patients with a history of substance abuse 6
- Pregabalin is classified as a Schedule V controlled substance due to potential for abuse and dependence 7
- Avoid abrupt discontinuation as this may precipitate withdrawal symptoms 4, 8
Special Populations
- Pregnancy: Contraindicated in individuals who are or may become pregnant 5
- Elderly patients: Lower starting doses and slower titration are recommended due to increased risk of adverse effects 3
- Patients with unmanaged hypertension: Use with caution due to potential cardiovascular effects 5
- Patients with seizure disorders: Abrupt discontinuation may increase seizure frequency 7
Important Monitoring Considerations
- Monitor for dizziness and somnolence, especially during dose titration 3
- Be vigilant for signs of angioedema or hypersensitivity reactions 1
- Monitor renal function in at-risk patients 2, 4
- Watch for signs of abuse or misuse, particularly in patients with a history of substance abuse 6
- Monitor for weight gain, which can occur with pregabalin therapy 3
Potential Side Effects Requiring Caution
- Dizziness (23-46% of patients) 3
- Somnolence (15-25% of patients) 3
- Peripheral edema (10% of patients) 3
- Dry mouth and constipation 3
- Weight gain 3
- Cognitive impairment, particularly in elderly patients 5
- Potential for acute angle-closure glaucoma 5
By understanding these contraindications and using appropriate caution in at-risk populations, clinicians can safely prescribe pregabalin while minimizing adverse outcomes.