How to manage pruritus associated with pregabalin (lyrica) therapy?

From the Guidelines

To manage pruritus caused by pregabalin, antiepileptic agents such as pregabalin itself or gabapentin can be used as second-line treatment, as they have been reported to induce relief of pruritus in the general patient population, according to the Annals of Oncology guidelines 1. When considering treatment options, it's essential to weigh the potential benefits and risks. Pregabalin and gabapentin have been shown to decrease pruritus at both the peripheral and central levels, making them viable options for managing itching associated with pregabalin use. Some key points to consider when managing pruritus from pregabalin include:

• Reducing the dose gradually under medical supervision may help decrease itching
• Applying cool compresses to itchy areas, using fragrance-free moisturizers, taking lukewarm showers, and wearing loose cotton clothing can provide symptom relief
• Over-the-counter antihistamines like cetirizine or diphenhydramine may provide temporary relief
• Topical corticosteroids can be prescribed for severe itching
• Alternative medications like gabapentin might cause less itching in some people It's crucial to consult with a healthcare provider before stopping or changing medication, as they can help determine the best course of treatment. Additionally, staying well-hydrated and avoiding alcohol while taking pregabalin may help reduce skin irritation, as suggested by general medical knowledge. In cases where itching is severe or accompanied by rash, swelling, or difficulty breathing, seeking immediate medical attention is necessary, as this could indicate a serious allergic reaction. The management of pruritus can be guided by the severity of the symptoms, with mild cases potentially being managed with topical interventions and oral antihistamines, as outlined in the Journal for ImmunoTherapy of Cancer 1.

From the Research

Pruritus from Pregabalin

• Pruritus is a distressing symptom that can be caused by various factors, including dermatologic, systemic, neurologic, or psychiatric disorders 2.
• Pregabalin, a medication used to treat neuropathic pain and epilepsy, has been studied for its potential antipruritic effects 2, 3.

Treatment of Pruritus with Pregabalin

• Studies have shown that pregabalin can be an effective option in reducing uremic pruritus, especially in patients who have not responded to antihistamines and topical moisturizers 2, 3.
• Pregabalin has also been found to be beneficial in treating pruritus in burn patients, prurigo nodularis, and chronic and idiopathic itch 2, 3.
• The therapeutic effects of pregabalin on uremic pruritus and post-burn itch may appear more rapidly than its effects on other conditions (1-2 weeks vs > 4 weeks) 2.

Efficacy and Safety of Pregabalin

• A systematic review and meta-analysis found that pregabalin and gabapentin demonstrated significant therapeutic value in the treatment of pruritus, with a favorable safety profile 4.
• The most common adverse effects of pregabalin include sedation, dizziness, and drowsiness 2, 4.
• Pregabalin has been found to be effective in reducing pruritus severity, as measured by visual analogue scale (VAS) scores and electric current perception threshold (CPT) values 5.

Comparison with Other Treatments

• Pregabalin and gabapentin have been found to be promising alternative treatments for pruritus, compared to commonly used treatments such as antihistamines and antidepressants 3, 4.
• Antihistamines, such as diphenhydramine and hydroxyzine, have been found to be effective in suppressing histamine-induced pruritus, but may have side effects such as drowsiness 6.