Drug Detail:Lyrica (Pregabalin [ pre-gab-a-lin ])
Drug Class: Gamma-aminobutyric acid analogs
1. How it works
- Lyrica is a brand (trade) name for pregabalin. Lyrica may be used in the treatment of some seizure disorders and also for the control of nerve pain.
- Research has shown that Lyrica binds strongly to a specific site (called the alpha2-delta site) on voltage-gated calcium channels. This action is thought to be the mechanism for its nerve-pain-relieving and anti-seizure properties.
- Lyrica belongs to the class of medicines known as gamma-aminobutyric acid analogs.
2. Upsides
- May be used to treat nerve pain associated with diabetes, shingles infection, and spinal cord injuries.
- May be used in addition to other medications for the treatment of partial-onset seizures.
- May be used in the management of fibromyalgia.
- Appears to have few drug interactions, although a compounding of side effects (such as sedation) may be seen if Lyrica is used with other drugs with similar side effects.
- Lyrica is available as a generic under the name pregabalin.
3. Downsides
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- May cause dizziness or drowsiness and affect a person's ability to drive or operate machinery. Alcohol should be avoided.
- May cause edema (fluid retention), particularly in the feet or hands. This may be noticed as weight gain, although weight gain can occur independently of fluid retention. Rarely, may cause potentially life-threatening angioedema (swelling of the face, mouth, or neck). People taking other medications that have also been associated with angioedema (such as ACE inhibitors) may be more at risk.
- Other side effects include a headache, tremors, abnormal thinking, dry mouth, constipation, blurred vision, lack of energy, changes in some laboratory test results (such as creatine kinase), and ECG changes.
- The dosage of Lyrica needs reducing in people with kidney disease.
- Similar to other medicines used to treat seizures, Lyrica is associated with an increased risk of depression and suicidal thoughts.
- Avoid abrupt or rapid discontinuation as discontinuation symptoms (including insomnia, nausea, headache, anxiety, increased sweating, and diarrhea) have been reported. Taper dosage down gradually on a doctor's advice over a minimum of one week.
- Information about the use of Lyrica during pregnancy is limited. Animal studies using up to 16 times the maximum recommended human dose have reported adverse effects on the offspring such as fetal structural abnormalities and decreased body weight. There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Lyrica during pregnancy (phone 1-888-233-2334 or http://www.aedpregnancyregistry.org/). Weigh up benefits to the mother versus risks to the fetus. Breastfeeding is not recommended during treatment with Lyrica due to the potential risk of tumorigenicity with pregabalin exposure via breast milk to the breastfed infant.
Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects
4. Tips
- May be taken with or without food.
- Do not stop abruptly; discontinue slowly over at least a week under your doctor's supervision. The exception is if you notice any facial or neck swelling, shortness of breath, or a skin rash then discontinue Lyrica immediately and seek urgent medical advice.
- Do not drive or operate machinery if Lyrica makes you drowsy or impairs your judgment.
- Notify your doctor if vision changes occur, if you experience unusual muscle pain or weakness, or if you are unexpectedly gaining weight.
- Talk to your doctor if you experience any worsening of your mood or develop suicidal thoughts.
- Tell your doctor if you are pregnant or breastfeeding before you start taking Lyrica because it may not be suitable for you. If you are planning to father a child, be aware that an association between Lyrica and birth defects has been reported in some animal studies.
5. Response and effectiveness
- Peak concentrations occur within 1.5 hours and effects last for approximately eight hours. Full anti-seizure or nerve-pain-relieving effects may take several weeks to develop, although some people may experience some relief during the first week of taking Lyrica.
6. Interactions
Medicines that interact with Lyrica may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Lyrica. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with pregabalin include:
- anti-anxiety medications, such as diazepam, lorazepam
- antidepressants, such as amitriptyline, citalopram, fluoxetine, paroxetine
- antihistamines, such as chlorpheniramine, promethazine
- antipsychotics, such as aripiprazole, chlorpromazine, haloperidol
- buprenorphine
- heart medications, such as ACE inhibitors (eg, benazepril, captopril, enalapril)
- narcotic pain relievers, such as oxycodone
- propoxyphene
- sedatives or sleeping pills
- some diabetes medications, such as pioglitazone, rosiglitazone
- tramadol.
Note that this list is not all-inclusive and includes only common medications that may interact with Lyrica. You should refer to the prescribing information for Lyrica for a complete list of interactions.