Lyrica exerts its activity by binding to the calcium channel receptor sites of the central nervous system thus reducing the release of many neurotransmitters which produce painful sensations and also slow down the impulses in the brain that transmit the feeling of pain. The medication is used to treat seizures and convulsions as an anti-epileptic drug by exerting similar properties to slow down impulses that produced the seizures.

Lyrica is indicated for the treatment of diabetic peripheral neuropathy (DPN). The dose recommended for the initial treatment is 50 to 100mg taken 3 times daily and increased to achieve desired results within the first week to a total of 300mg daily as tolerated by the patient.

For those patients diagnosed with the pain of shingles (post herpetic neuralgia, PHN) the similar dosage if required. In severe cases and those patients with normal renal clearance, as is not the case with diabetic patients with long term well established poor control, the dose may increase to a total of 600mg daily under close supervision. Doses higher than the 300mg daily up to 600mg daily is only recommended for those patients not responding to pain relief and tolerate the medication with minimal side effects. The medication must be cautiously used with lower doses in patients with renal diseases of reduced function.

The patient with a partial type of seizure disorder known as partial onset seizures may be prescribed the medication as an adjunct to other medications. Doses of 150-600mg daily are beneficial for the added control necessary.

Another very painful medical disorder that has also increased frequency is fibromyalgia. Similar dosing recommendations of 300-450mg daily are used.

Pregabalin is well absorbed orally attaining peak blood levels in 1 ½ hours and may be taken with or without food, and is excreted primarily by the kidneys with minimal metabolic changes.

No drug interactions occur with simultaneous administration of lorazepam, (a benzodiazepine used for anxiety), oxycodone, (a narcotic analgesic), or other antiepileptic drugs such as phenytoin, carbamazepine, tiagabine, or valproic acid. There is no adverse reaction with the diuretic furosemide or the diabetic medication glyburide Pregabalin should not be abruptly stopped, but the dosage reduced gradually over 1-2 weeks.

Side effects of the medication include dizziness, somnolence (drowsiness) blurred vision, weight gain, peripheral edema (swelling of the extremities) a decrease in platelet count-but does not cause an increase in bleeding tendency. It may cause drying of the mouth, constipation and flatulence (gas) headaches, flu like symptoms, confusion and vomiting. Patients on the medication, regardless of the disease being treated, should undergo routine eye exams and blood lab tests including complete blood count (CBC) and renal studies. The drug should be avoided in pregnant, lactating and pediatric patients.

Pregabalin is available as 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, and 300mg capsules for convenience of dosage flexibility as described since severity of symptoms, response, renal clearance and function, and tolerance due to side effects are all considerations in achieving the most appropriate dose for each patient.

REFERENCES

PHYSICIAN’S DESK REFERENCE, PDR Volume 61 2007

MPR, MONTHLY PRESCRIBING REFERENCE, PODIATRY EDITION 2009

DRUGS.COM, PREGABALIN- LYRICA

The indication for Pregabalin in my podiatric practice is the painful presentation of diabetic peripheral neuropathy, DPN. In those patients which are classified as pre-diabetic or recently diagnosed diet/exercise controlled diabetics with no present symptoms evaluated either subjectively(by the patient’s discussion through question and answer) or by a neurologic exam consisting of vibration, proprioception(spatial relation of the lower extremity) sharp/dull, hot/cold, I usually begin the treatment of prevention with a topical amino acid-arginine cream such as Diabetiderm which exerts is action to reduce the chemical homocysteine which has deleterious effects on the nervous system along with addition of vitamin B6 tablets. If symptoms are already present, I also add the prescription vitamin, presently classified as a “food supplement” soon to be reclassified by the FDA, Metanx, which contains B6, B12, and a specialized bioavailable formulation of folic acid. Patients with increased symptoms of neuropathy, not being treated by their physician for the symptoms, I begin the Pregabalin in the recommended doses after reviewing recent labs including CBC/differential and Renal function from their family doctor, internist, or endocrinologist. I have found the step-wise approach very beneficial for the patient, the relief noted is well appreciated by the patient in restoring some quality of life.

ADDITIONAL REFERENCES

Drugs.com

Medscape

MedlinePlus

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