Pregabalin (Lyrica)
Anticonvulsant | Central Nervous System Agent | All
- Indications for Use: Ensure you are clear on the FDA-approved indications for pregabalin which include neuropathic pain associated with diabetic peripheral neuropathy, post-herpetic neuralgia, fibromyalgia, and spinal cord injury, as well as adjunctive therapy for adult patients with partial-onset seizures.
- Dosing Adjustments: Pregabalin requires dose adjustments in patients with renal impairment. Start with a lower dose and adjust according to the creatinine clearance. This is crucial to prevent toxicity due to decreased renal excretion.
- Side Effects Profile: Educate patients about common and serious side effects including dizziness, somnolence, dry mouth, and potential weight gain. More serious side effects may include angioedema, hypersensitivity reactions, or misuse potential, particularly in patients with a history of substance abuse.
- Withdrawal Symptoms: Warn patients against abrupt discontinuation of pregabalin to avoid withdrawal symptoms. Gradually taper the dose over a minimum of one week under a doctor's supervision.
- Suicidal Behavior and Ideation: Monitor all patients taking pregabalin for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.
- Potential for Misuse: Highlight the potential for pregabalin misuse and dependence, especially in patients with a history of substance abuse disorders. Consider these factors in risk assessment and counseling.
- Effect on Concomitant Drug Therapy: Pregabalin may potentiate the effects of ethanol and lorazepam. Care should be taken when it is used concurrently with these substances due to increased CNS depressant effects.
- Pregnancy and Nursing: Advise that pregabalin is categorized as Pregnancy Category C based on animal studies showing adverse effects. It should be used during pregnancy only if the potential benefits justify the potential risk to the fetus. It is also excreted in human milk, and caution should be exercised when administered to a nursing mother.
- Elderly Population: Use caution when prescribing pregabalin to elderly patients as they are generally more sensitive to the effects of CNS depressants and may exhibit greater susceptibility to adverse effects, such as CNS depression and accidental injury.
- Effectiveness for Off-label Uses: While pregabalin is often used off-label for conditions such as anxiety disorders or insomnia, it is important for healthcare providers to base such use on sound clinical judgment and patient needs, recognizing that not all off-label uses are supported by robust clinical evidence.
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=d4734e7d-5079-455e-8ff5-8f4539c998a9&type=display —
prescribing information
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