Indications for Lyrica (Pregabalin) Use
Lyrica (pregabalin) is primarily indicated for neuropathic pain conditions including diabetic peripheral neuropathy, postherpetic neuralgia, fibromyalgia, and neuropathic pain associated with spinal cord injury. 1
FDA-Approved Indications
- Management of neuropathic pain associated with diabetic peripheral neuropathy 1
- Management of postherpetic neuralgia 1
- Management of fibromyalgia 1
- Management of neuropathic pain associated with spinal cord injury 1
- Adjunctive therapy for partial-onset seizures in patients 1 month of age and older 1
Neuropathic Pain Management
Diabetic Peripheral Neuropathy
- Pregabalin is recommended as a first-line oral treatment for diabetic peripheral neuropathy 2
- Starting dose is typically 50 mg three times daily, which may be increased to a maximum of 300 mg daily based on efficacy and tolerability 3
- Most patients who respond to pregabalin will show improvement within the first 3-4 weeks of treatment 4
Postherpetic Neuralgia
- Pregabalin is FDA-approved for postherpetic neuralgia management 1
- For patients with HIV who have inadequate response to gabapentin, pregabalin may be considered for post-herpetic neuralgia 2
- Pregabalin has demonstrated efficacy at doses of 300 mg, 450 mg, and 600 mg daily (but not at 150 mg) for postherpetic neuralgia 2
Fibromyalgia Management
- Pregabalin is FDA-approved and recommended for the treatment of fibromyalgia 2
- In patients with fibromyalgia, pregabalin is associated with small to moderate improvements in pain, function, and quality of life 2
- Pregabalin is one of three FDA-approved medications for fibromyalgia, alongside duloxetine and milnacipran 2
- Typical effective doses range between 300-600 mg/day in divided doses 2
Use in Specific Populations
Older Adults
- Lower starting doses should be used in older adults due to increased risk of adverse effects 2
- Starting dose of 25-50 mg/day is appropriate with gradual titration based on response 2
- Caution is warranted due to potential for dizziness and somnolence, which may increase fall risk 2
Patients with Renal Impairment
- Dose adjustment is required for patients with renal impairment 3
- Pregabalin is eliminated unchanged in urine, so even moderate renal failure (creatinine clearance below 60 ml/min) requires dose reduction 5
Common Adverse Effects
- Most common adverse effects are neuropsychological reactions, primarily dizziness (up to 49%) and somnolence (up to 50%) 6
- Other common side effects include headache (up to 29%), weight gain, and peripheral edema 5, 6
- Most adverse events emerge within the first 3-4 weeks of treatment 4
- Somnolence is reported by up to 80% of patients taking pregabalin 2
Practical Considerations
- Pregabalin has a high oral bioavailability (approximately 90%) 7
- Food does not significantly affect the extent of absorption 7
- Pregabalin has minimal hepatic metabolism and limited drug interactions, making it advantageous in patients on multiple medications 3
- Pregabalin is classified as a Schedule V controlled substance due to potential for abuse and dependence 3
When Not to Use Pregabalin
- Pregabalin should not be considered as first-line therapy for conditions where other treatments have better evidence of efficacy 5
- For chronic pain conditions not specifically approved in the labeling, other therapies should be considered first 2
- In patients with severe renal impairment, careful dose adjustment is necessary 5
Monitoring Recommendations
- Monitor for improvement in pain scores within the first 3-4 weeks of treatment 4
- If no response is observed after 4 weeks at an adequate dose, consider alternative therapy 4
- Watch for adverse effects, particularly dizziness and somnolence, which typically emerge early in treatment 4
- Monitor for weight gain and peripheral edema, especially in elderly patients 5
By following these evidence-based guidelines for pregabalin use, clinicians can appropriately select patients who are most likely to benefit from this medication while minimizing adverse effects.