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Lyrica
pregabalin
Adult Dosing .
Dosage forms: CAP: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg; SOL: 20 mg per mL
neuropathic pain, diabetic
- [50-100 mg PO tid]
- Start: 50 mg PO tid, may incr. to 100 mg PO tid w/in 1wk; Max: 600 mg/day; Info: doses >300 mg/day rarely more effective, may incr. ADR risk; taper dose over >1wk to D/C
neuropathic pain, spinal cord injury-assoc.
- [75-300 mg PO bid]
- Start: 75 mg PO bid, may incr. to 150 mg PO bid w/in 1wk, then may incr. to 300 mg PO bid after another 2-3wk; Max: 600 mg/day; Info: taper dose over >1wk to D/C
post-herpetic neuralgia
- [150-300 mg/day PO divided bid-tid]
- Start: 150 mg/day PO divided bid-tid, may incr. to 300 mg/day PO divided bid-tid w/in 1wk, then may incr. to 600 mg/day PO divided bid-tid after another 2-4wk; Max: 600 mg/day; Info: taper dose over >1wk to D/C
partial seizures, adjunct tx
- [150-600 mg/day PO divided bid-tid]
- Start: 150 mg/day PO divided bid-tid; Max: 600 mg/day; Info: taper dose over >1wk to D/C
fibromyalgia
- [150-225 mg PO bid]
- Start: 75 mg PO bid, may incr. to 150 mg PO bid w/in 1wk; Max: 450 mg/day; Info: taper dose over >1wk to D/C
anxiety (off-label)
- [150-600 mg/day PO divided bid-tid]
- Start: 150 mg/day PO divided bid-tid, may incr. by 150 mg/day PO qwk; Max: 600 mg/day; Info: taper dose over >1wk to D/C
renal dosing
- [if usual dose 150 mg/day]
- CrCl 30-60: 75 mg/day divided bid-tid; CrCl 15-29: 25-50 mg/day divided qd-bid; CrCl <15: 25 mg qd
- HD: 25 mg qd; give 25-50 mg as supplement after dialysis if next maint. dose not due right after dialysis; PD: not defined
- [if usual dose 300 mg/day]
- CrCl 30-60: 150 mg/day divided bid-tid; CrCl 15-29: 75 mg/day divided qd-bid; CrCl <15: 25-50 mg qd
- HD: 25-50 mg qd; give 50-75 mg as supplement after dialysis if next maint. dose not due right after dialysis; PD: not defined
- [if usual dose 450 mg/day]
- CrCl 30-60: 225 mg/day divided bid-tid; CrCl 15-29: 100-150 mg/day divided qd-bid; CrCl <15: 50-75 mg qd
- HD: 50-75 mg qd; give 75-100 mg as supplement after dialysis if next maint. dose not due right after dialysis; PD: not defined
- [if usual dose 600 mg/day]
- CrCl 30-60: 300 mg/day divided bid-tid; CrCl 15-29: 150 mg/day divided qd-bid; CrCl <15: 75 mg qd
- HD: 75 mg qd; give 100-150 mg as supplement after dialysis if next maint. dose not due right after dialysis; PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: CAP: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg; SOL: 20 mg per mL
partial seizures, adjunct tx
- [1 mo-3 yo, <30 kg]
- Dose: 3.5-14 mg/kg/day PO divided tid; Start: 3.5 mg/kg/day PO divided tid, may incr. dose qwk; Max: 14 mg/kg/day; Info: taper dose over >1wk to D/C
- [1 mo-3 yo, >30 kg]
- Dose: 2.5-10 mg/kg/day PO divided bid-tid; Start: 2.5 mg/kg/day PO divided bid-tid, may incr. dose qwk; Max: 10 mg/kg/day up to 600 mg/day; Info: taper dose over >1wk to D/C
- [4 yo and older, <30 kg]
- Dose: 3.5-14 mg/kg/day PO divided bid-tid; Start: 3.5 mg/kg/day PO divided bid-tid, may incr. dose qwk; Max: 14 mg/kg/day; Info: taper dose over >1wk to D/C
- [4 yo and older, >30 kg]
- Dose: 2.5-10 mg/kg/day PO divided bid-tid; Start: 2.5 mg/kg/day PO divided bid-tid, may incr. dose qwk; Max: 10 mg/kg/day up to 600 mg/day; Info: taper dose over >1wk to D/C
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- CrCl <30 (ER form)
- abrupt withdrawal
- avoid: alcohol use
- caution: hypersensitivity to tartrazine (some generic forms)
- caution: renal impairment
- caution: elderly pts
- caution: CHF, NYHA Class III-IV
- caution: angioedema hx
- caution: angioedema risk
- caution: depression
- caution: depression hx
- caution: respiratory impairment
- caution: CNS depressant use, concurrent
- caution: substance abuse risk
Drug Interactions .
Overview
pregabalin
GABA analog
- affected by altered fat absorption
- angioedema
- antiepileptic agent
- CNS depression
Contraindicated
- amifampridine
- bupropion
- dalfampridine
Avoid/Use Alternative
- buprenorphine
- butalbital
- butorphanol
- clonidine
- codeine
- diazepam
- dihydrocodeine
- doxylamine
- ethanol
- fentanyl
- ginkgo
- hydrocodone
- hydromorphone
- isocarboxazid
- kava
- kratom
- levorphanol
- lindane topical
- lorazepam
- meperidine
- metaxalone
- methadone
- metoclopramide
- midazolam
- morphine
- nalbuphine
- oliceridine
- opium
- oxybate
- oxycodone
- oxymorphone
- pentazocine
- phenelzine
- promethazine
- ropeginterferon alfa-2b
- tapentadol
- thalidomide
- tramadol
- tranylcypromine
- trimethobenzamide
- zuranolone
Monitor/Modify Tx
- 5-HTP
- aldesleukin
- alfentanil
- allopurinol
- almotriptan
- alprazolam
- amantadine
- amitriptyline
- amoxapine
- apomorphine
- apraclonidine ophthalmic
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- asenapine
- baclofen
- baclofen intrathecal
- brexpiprazole
- brimonidine topical
- brivaracetam
- bromocriptine
- brompheniramine
- buspirone
- cannabidiol
- cannabis
- carbamazepine
- carbinoxamine
- cariprazine
- carisoprodol
- cenobamate
- cetirizine
- chamomile, German
- chlophedianol
- chlordiazepoxide
- chlorpheniramine
- chlorpromazine
- chlorzoxazone
- citalopram
- clemastine
- clobazam
- clomipramine
- clonazepam
- clorazepate
- clozapine
- cyclobenzaprine
- cyproheptadine
- dantrolene
- daridorexant
- darifenacin
- desflurane
- desipramine
- desvenlafaxine
- deutetrabenazine
- dexbrompheniramine
- dexchlorpheniramine
- dexmedetomidine
- dexmedetomidine injection
- dichlorphenamide
- difelikefalin
- difenoxin
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- domperidone
- doxepin
- doxepin topical
- dronabinol
- droperidol
- duloxetine
- efavirenz
- eletriptan
- entacapone
- entrectinib
- escitalopram
- esketamine
- eslicarbazepine acetate
- estazolam
- eszopiclone
- ethanol (in some formulations)
- ethosuximide
- etomidate
- felbamate
- fenfluramine
- fesoterodine
- flibanserin
- fluoxetine
- fluphenazine
- flurazepam
- fluvoxamine
- foslevodopa
- fosphenytoin
- frovatriptan
- gabapentin
- gabapentin enacarbil
- ganaxolone
- glofitamab
- glycopyrrolate
- guanfacine
- haloperidol
- hydroxyzine
- hyoscyamine
- ifosfamide
- iloperidone
- imipramine
- isoflurane
- ketamine
- lacosamide
- lamotrigine
- lasmiditan
- lemborexant
- levetiracetam
- levocetirizine
- levodopa
- levomilnacipran
- lofexidine
- loxapine
- lumateperone
- lurasidone
- meclizine
- melatonin
- meprobamate
- methocarbamol
- methohexital
- methsuximide
- methyldopa
- metyrapone
- metyrosine
- milnacipran
- mirtazapine
- mitotane
- molindone
- mosunetuzumab
- mycophenolate mofetil
- naltrexone
- naratriptan
- nefazodone
- nelarabine
- nortriptyline
- olanzapine
- opicapone
- orphenadrine
- oxazepam
- oxcarbazepine
- oxybutynin
- paliperidone
- paroxetine
- passion flower
- pentobarbital
- perampanel
- perphenazine
- pheniramine
- phenobarbital
- phenytoin
- pimozide
- pramipexole
- primidone
- procarbazine
- prochlorperazine
- propofol
- protriptyline
- pyrilamine
- quazepam
- quetiapine
- ramelteon
- rasagiline
- remifentanil
- remimazolam
- repotrectinib
- risperidone
- rizatriptan
- ropinirole
- rotigotine transdermal
- rufinamide
- safinamide
- scopolamine
- selegiline
- selegiline transdermal
- selinexor
- sertraline
- sevoflurane
- solifenacin
- stiripentol
- sufentanil
- sumatriptan
- suvorexant
- tasimelteon
- temazepam
- tetrabenazine
- thioridazine
- thiotepa
- thiothixene
- tiagabine
- tizanidine
- tolcapone
- tolterodine
- topiramate
- trazodone
- triazolam
- trifluoperazine
- trihexyphenidyl
- trimipramine
- triprolidine
- trospium
- valbenazine
- valerian
- valproic acid
- venlafaxine
- vigabatrin
- vilazodone
- viloxazine
- zaleplon
- ziconotide
- ziprasidone
- zolmitriptan
- zolpidem
- zonisamide
Caution Advised
- acyclovir
- aminophylline
- amoxicillin
- amphetamine
- ampicillin
- apalutamide
- aripiprazole bimonthly injection
- axicabtagene ciloleucel
- benazepril
- benzphetamine
- betamethasone
- brexucabtagene autoleucel
- brimonidine ophthalmic
- busulfan
- captopril
- cefazolin
- cefepime
- cefiderocol
- ceftaroline
- ceftazidime
- ceftobiprole
- chlorambucil
- chloroquine
- ciltacabtagene autoleucel
- ciprofloxacin
- cisatracurium
- cocaine
- cortisone
- cycloserine
- cyclosporine
- darbepoetin alfa
- darolutamide
- deflazacort
- delafloxacin
- dexamethasone
- dexmethylphenidate
- dextroamphetamine
- dicloxacillin
- diethylpropion
- donepezil
- elivaldogene autotemcel
- enalapril
- enalaprilat
- enzalutamide
- ephedra
- epoetin alfa
- ertapenem
- everolimus
- foscarnet
- fosinopril
- galantamine
- ganciclovir
- goserelin
- histrelin
- hydroxychloroquine
- idecabtagene vicleucel
- imipenem
- interferon beta 1a
- interferon beta 1b
- iohexol
- iopamidol
- isoniazid
- ketorolac
- leuprolide
- levocarnitine
- levofloxacin
- lidocaine
- lidocaine topical
- linezolid
- lisdexamfetamine
- lisinopril
- lisocabtagene maraleucel
- lithium
- lorlatinib
- magnesium citrate
- mefloquine
- meropenem
- methamphetamine
- methotrexate
- methoxy polyethylene glycol-epoetin beta
- methylphenidate
- metronidazole
- mexiletine
- moexipril
- moxifloxacin
- nafarelin
- nafcillin
- obecabtagene autoleucel
- ofloxacin
- oxacillin
- peginterferon beta 1a
- penicillin G
- penicillin V
- perindopril
- phendimetrazine
- phentermine
- pioglitazone
- piperacillin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pyridostigmine
- pyrimethamine
- quinapril
- quinine
- ramipril
- regadenoson
- rivastigmine
- rosiglitazone
- sacubitril
- sirolimus
- sirolimus topical
- sodium picosulfate
- sulfate bowel prep
- tacrolimus
- teclistamab
- temsirolimus
- terbutaline
- theophylline
- tinidazole
- tisagenlecleucel
- trandolapril
- tranexamic acid
- treosulfan
- triamcinolone
- triptorelin
- vadadustat
- valacyclovir
- valganciclovir
- varenicline
Adverse Reactions .
Serious Reactions
- hypersensitivity rxn
- anaphylactoid rxn
- angioedema
- exfoliative dermatitis
- Stevens-Johnson syndrome
- thrombocytopenia
- rhabdomyolysis
- suicidality, incl. after tx D/C
- respiratory depression
- withdrawal seizures if abrupt D/C
- withdrawal sx if abrupt D/C
- abuse potential
Common Reactions
- dizziness
- somnolence
- xerostomia
- peripheral edema
- blurred vision
- nausea
- weight gain
- headache
- abnormal thinking
- constipation
- impaired coordination
- pain
- platelets decr.
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; s/sx depression, behavior changes, suicidality during tx and after D/C
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; possible risk of teratogenicity based on conflicting human data; risk of neonatal withdrawal syndrome w/ near term use inconclusive; risk of embryo-fetal toxicity and death based on animal data at 2x recommended human dose
Pregnancy Registry
encourage pts to enroll in North American Antiepileptic Drug Pregnancy Registry at 1-888-233-2334 or www.aedpregnancyregistry.org
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; inadequate human data available to assess risk of infant harm, though drug excreted into milk; theoretical risk of tumorigenicity based on animal data; no human data available to assess effects on milk production
Pharmacology .
Metabolism: none; CYP450: none
Excretion: urine (90% unchanged); Half-life: 6.3h (adults), 3-6h (peds)
Subclass: Anxiolytics, Non-benzodiazepines ; Fibromyalgia ; Neuropathy/Neuralgia ; Seizure Disorders
Mechanism of Action
exact mechanism of action unknown; binds alpha2-delta subunit of calcium channels reducing neurotransmitter release; produces antinociceptive and antiseizure effects
Formulary .
No Formulary Selected
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