What Lyrica (Pregabalin) Treats
Lyrica 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 300-600 mg daily (divided doses) significantly reduces pain scores compared to placebo, with the starting dose of 50 mg three times daily increased to 300 mg daily within one week based on tolerability 1, 2
- Postherpetic neuralgia: Pregabalin 450-600 mg daily provides significant pain relief and improves sleep interference, with the best NNT (number needed to treat) of 3.9 for at least 50% pain relief at 600 mg daily 3, 1
- Spinal cord injury-related neuropathic pain: FDA-approved indication with dosing similar to other neuropathic pain conditions 1
Fibromyalgia
- Pregabalin is the first FDA-approved medication specifically for fibromyalgia, started at 75 mg twice daily and increased to 150 mg twice daily within one week 1, 4
- The NNT for substantial benefit (at least 50% pain relief) is 11 at 600 mg daily, which is higher (less effective) than for neuropathic pain conditions 3
- Multiple guidelines recommend pregabalin as first-line pharmacological therapy for fibromyalgia, either alone or combined with duloxetine if monotherapy fails 4, 5
Seizure Disorders
- Adjunctive therapy for partial-onset seizures in patients 1 month of age and older, with starting doses of 75 mg twice daily or 50 mg three times daily, increased up to 600 mg daily based on response 1, 2
Off-Label Uses Supported by Guidelines
Chronic Pain Conditions with Limited Evidence
- HIV-associated neuropathic pain: Guidelines suggest considering pregabalin for patients with postherpetic neuralgia in HIV populations after inadequate response to gabapentin 5
- Cancer-related neuropathic pain: Pregabalin is among the commonly used anticonvulsants for cancer pain, though primarily studied in conjunction with opioids 5
Conditions Where Pregabalin is NOT Effective
- Chronic low back pain (nonradicular): Two fair-quality trials found pregabalin had no effect on pain intensity (differences of only 0.14-0.21 points on 0-10 scale) and actually worsened function scores 5
- Acute postoperative pain: No clear evidence of beneficial effects 3
- Chronic arthritis or other nociceptive pain: No studies support use in these conditions 3
Mechanism and Clinical Considerations
- Pregabalin binds to the alpha2-delta subunit of voltage-gated calcium channels, reducing neurotransmitter release and neuronal excitability 6
- The drug exhibits linear pharmacokinetics, is not metabolized, and is eliminated unchanged by the kidneys, requiring dose adjustment in renal insufficiency 7
- Common adverse effects include dizziness (27-46%), somnolence (15-25%), and weight gain, with 18-28% discontinuing due to adverse events at 600 mg daily 3, 5
- Pregabalin is a Schedule V controlled substance due to potential for abuse and dependence 2