What is Lyrica (pregabalin) used for?

Lyrica (Pregabalin) Indications

Lyrica (pregabalin) is FDA-approved for five specific conditions: neuropathic pain from diabetic peripheral neuropathy, postherpetic neuralgia, fibromyalgia, neuropathic pain from spinal cord injury, and as adjunctive therapy for partial-onset seizures in patients 1 month of age and older. 1

FDA-Approved Indications

Neuropathic Pain Conditions

• Diabetic peripheral neuropathy: Pregabalin is FDA-approved and recommended as first-line treatment for painful diabetic neuropathy 2
• Postherpetic neuralgia: Both pregabalin and gabapentin are FDA-approved for this indication, with pregabalin showing small improvements in neuropathic pain 2
• Spinal cord injury-related neuropathic pain: FDA-approved indication for managing this specific type of nerve pain 1

Fibromyalgia

• Fibromyalgia management: Pregabalin is FDA-approved and recommended, showing small to moderate improvements in pain, function, and quality of life 2
• Patients are more likely to report improvement with an NNT (number needed to treat) of 4.8 3

Epilepsy

• Partial-onset seizures: Approved as adjunctive therapy when taken with other seizure medicines in patients 1 month of age and older 1
• Up to 51% responder rate at 600 mg/day dose for refractory partial-onset seizures 4

Mechanism and Pharmacology

• Pregabalin binds to the alpha-2-delta subunit of voltage-gated calcium channels in presynaptic neurons, inhibiting excitatory neurotransmitter release 4, 5
• It has linear pharmacokinetics with approximately 90% oral bioavailability, no protein binding, and no hepatic metabolism 6, 7
• The drug is eliminated unchanged primarily through renal excretion, requiring dose adjustment in renal impairment 1, 7

Dosing Framework

Standard Dosing Ranges

• Starting dose: 75 mg twice daily or 50 mg three times daily (150 mg/day total) 3
• Moderate dose: 300 mg/day (typically 150 mg twice daily or 100 mg three times daily) 3
• Maximum dose: 600 mg/day in 2-3 divided doses 3

Titration Strategy

• Initial effects are noticeable within 1 week of starting therapy 3
• For postherpetic neuralgia, increase to 300 mg/day within 1 week based on efficacy and tolerability 3
• Higher doses (>300 mg/day) often don't provide additional benefits but increase side effects 3
• An adequate trial requires 4 weeks at therapeutic dose before determining effectiveness 3

Critical Safety Considerations

High-Risk Combinations

• Serious breathing problems can occur when pregabalin is combined with opioid pain medications, benzodiazepines, or other CNS depressants 3, 1
• Watch for increased sleepiness or decreased breathing when starting or increasing doses 1

Common Adverse Effects

• Dizziness (23-46%), somnolence (15-25%), and peripheral edema (10%) are dose-dependent 3
• Other common effects include dry mouth, constipation, weight gain, and visual disturbances 2, 3

Special Populations

• Elderly patients (≥65 years): Require lower starting doses and slower titration due to increased risk of dizziness, somnolence, confusion, balance disorder, tremor, and falls 3, 1
• Renal impairment: Mandatory dose reduction—approximately 50% reduction for CrCl 30-60 mL/min, 75% for CrCl 15-30 mL/min, and 85-90% for CrCl <15 mL/min 3, 1

Discontinuation

• Taper gradually over a minimum of 1 week when discontinuing to avoid withdrawal symptoms 3, 1

Clinical Context

Pregabalin should not be considered first-line therapy for all chronic pain conditions—expected benefits must be weighed against risks before initiating therapy 2. In conditions like headache, expected benefits are unlikely to outweigh risks regardless of previous therapies used 2.