pregabalin

(pre-gab-a-lin) pregabalin,

Lyrica

(trade name)

Classification

Therapeutic: analgesics
Pharmacologic: gamma aminobutyric acid gaba analogues
Pregnancy Category: C

Indications

Neuropathic pain associated with diabetic peripheral neuropathyPostherpetic neuralgiaFibromyalgiaNeuropathic pain associated with spinal cord injuryAdjunctive therapy of partial-onset seizures in adults.

Action

Binds to calcium channels in CNS tissues which regulate neurotransmitter release. Does not bind to opioid receptors.

Therapeutic effects

Decreased neuropathic or post-herpetic pain.Decreased partial-onset seizures.

Pharmacokinetics

Absorption: Well absorbed (90%) following oral administration.Distribution: Probably crosses the blood-brain barrier.Metabolism and Excretion: Minimally metabolized, 90% excreted unchanged in urine.Half-life: 6 hr.

Time/action profile (↓ post–herpetic pain)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2–4 wk	unknown

Contraindications/Precautions

Contraindicated in: Myopathy (known/suspected); Lactation: Lactation.Use Cautiously in: All patients (may ↑ risk of suicidal thoughts/behaviors);Renal impairment (dose alteration recommended for CCr <60 mL/min);HF;History of drug dependence/drug-seeking behavior; Obstetric: Use only if maternal benefit outweighs fetal risk; may ↑ risk of male-mediated teratogenicity; Pediatric: Safety not established; Geriatric: Consider age-related ↓ in renal function when determining dose.

Adverse Reactions/Side Effects

Central nervous system

suicidal thoughts (life-threatening)
dizziness (most frequent)
drowsiness (most frequent)
impaired attention/concentration/thinking

Cardiovascular

edema (most frequent)

Ear, Eye, Nose, Throat

blurred vision

Gastrointestinal

dry mouth (most frequent)
abdominal pain
constipation
↑ appetite
vomiting

Hematologic

thrombocytopenia

Metabolic

weight gain

Miscellaneous

allergic reactions
fever

Interactions

Drug-Drug interaction

Concurrent use with thiazolidinediones (pioglitazone,rosiglitazone ) may ↑ risk of fluid retention.↑ risk of CNS depression with other CNS depressants including opioids, alcohol, benzodiazepines, or other sedatives/hypnotics.

Route/Dosage

Diabetic Neuropathic Pain

Oral (Adults) 50 mg 3 times daily, ↑ over 7 days up to 100 mg 3 times daily

Postherpetic Neuralgia

Oral (Adults) 75 mg twice daily or 50 mg 3 times daily initially, may be ↑ over 7 days to 300 mg/day in 2–3 divided doses; after 2–4 wk may be ↑ to 600 mg/day in 2–3 divided doses

Fibromyalgia

Oral (Adults) 75 mg twice daily initially, may be ↑ to 150 mg twice daily within 1 wk based on efficacy and tolerability. May be ↑ to 225 twice daily

Spinal Cord Injury Neuropathic Pain

Oral (Adults) 75 mg twice daily initially, may be ↑ to 150 mg twice daily within 1 wk based on efficacy and tolerability; if insufficient pain relief after 2–3 wk, may ↑ to 300 twice daily

Partial Onset Seizures

Oral (Adults) 75 mg twice daily or 50 mg 3 times daily initially; may be gradually ↑ to 600 mg/day

Renal Impairment

Oral (Adults) CCr 30–60 mL/min—75–300 mg/day in 2–3 divided doses; CCr 15–30 mL/min—25–150 mg/day in 1–2 divided doses; CCr < 15 mL/min—25–75 mg/day as a single daily dose

Availability (generic available)

Capsules: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg Cost: 25 mg $411.71 / 100, 50 mg $409.80 / 100, 75 mg $409.80 / 100, 100 mg $409.80 / 100, 150 mg $409.80 / 100, 200 mg $411.71 / 100, 225 mg $411.71 / 100Oral solution: 20 mg/mL Cost: $553.82 / 473 mL

Nursing implications

Nursing assessment

Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.
Diabetic Peripheral Neuropathy, Postherpetic Neuralgia, Fibromyalgia, and Spinal Cord Injury Pain: Assess location, characteristics, and intensity of pain periodically during therapy.
Seizures: Assess location, duration, and characteristics of seizure activity.
Lab Test Considerations: May cause ↑ creatine kinase levels.
- May cause↓ platelet count.

Potential Nursing Diagnoses

Risk for injury (Adverse Reactions)

Implementation

Do not confuse Lyrica (pregabalin) with Lopressor (metoprolol).
Pregabalin should be discontinued gradually over at least 1 wk. Abrupt discontinuation may cause insomnia, nausea, headache, anxiety, sweating, and diarrhea when used for pain and may cause increase in seizure frequency when treating seizures.
Oral: May be administered without regard to meals. Oral solution may be stored at room temperature.

Patient/Family Teaching

Instruct patient to take medication as directed. If a dose is missed take as soon as remembered unless almost time for next dose; do not double doses. Do not discontinue abruptly; may cause insomnia, nausea, headache, or diarrhea or increase in frequency of seizures. Advise patient to read the Patient Information Leaflet prior to taking pregabalin.
May cause dizziness, drowsiness, and blurred vision. Caution patient to avoid driving or activities requiring alertness until response to medication is known. Advise patient to notify health care professional if changes in vision occur. Patients with seizures should not resume driving until health care professional gives clearance based on control of seizure disorder.
Instruct patient to promptly report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever. Discontinue therapy if myopathy is diagnosed or suspected or if markedly elevated creatine kinase levels occur.
Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur.
Inform patient that pregabalin may cause edema and weight gain.
Caution patient to avoid alcohol or other CNS depressants with pregabalin.
Instruct patient to notify health care professional of medication regimen before treatment or surgery.
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding. Inform male patients who plan to father a child of the potential risk of male-mediated teratogenicity. Encourage patients who become pregnant to enroll in the NAAED Pregnancy Registry by calling 1–800–233–2334.
Advise patient to carry identification describing disease process and medication regimen at all times.

Evaluation/Desired Outcomes

Decrease in intensity of chronic pain.
Decrease in the frequency or cessation of seizures.