Lyrica (pregabalin) is a prescription medication specifically formulated for the management of neuropathic pain, offering targeted relief for conditions stemming from nerve damage. As a successor to gabapentin, it exhibits superior pharmacokinetic properties, including higher bioavailability and a more predictable dose-response relationship. This anticonvulsant and anxiolytic agent binds to the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, modulating neurotransmitter release and reducing neuronal hyperexcitability. Clinically, it is indicated for diabetic peripheral neuropathy, postherpetic neuralgia, fibromyalgia, and as adjunctive therapy for partial-onset seizures in adults. Its well-established efficacy profile makes it a cornerstone in neuropathic pain management protocols.

Features

• Active ingredient: Pregabalin
• Available strengths: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg capsules; 20 mg/mL oral solution
• Pharmacologic class: Gabapentinoid, anticonvulsant
• Mechanism of action: Binds to alpha-2-delta subunit of voltage-gated calcium channels
• Half-life: Approximately 6.3 hours
• Bioavailability: ≥90% and dose-independent
• Excretion: Primarily renal (90% unchanged)
• Scheduling: CV (controlled substance) in many jurisdictions

Benefits

• Provides significant reduction in neuropathic pain scores within first week of treatment
• Improves sleep quality and reduces pain-related sleep interference
• Demonstrates efficacy in managing fibromyalgia symptoms including widespread pain and fatigue
• Offers adjunctive control for partial-onset seizures with predictable pharmacokinetics
• Reduces symptoms of generalized anxiety disorder in adults
• Shows linear pharmacokinetics allowing for straightforward dose titration

Common use

Lyrica is primarily prescribed for neuropathic pain conditions including diabetic peripheral neuropathy and postherpetic neuralgia. It received FDA approval for fibromyalgia management in 2007, representing one of the first medications specifically indicated for this condition. Neurologists frequently utilize it as adjunctive therapy for partial-onset seizures when first-line antiepileptic drugs provide insufficient control. Off-label uses include neuropathic pain associated with spinal cord injury, central neuropathic pain, and restless legs syndrome. The medication has also demonstrated efficacy in generalized anxiety disorder, though this indication varies by regulatory jurisdiction.

Dosage and direction

Initiate treatment at 150 mg daily divided into two or three doses (75 mg twice daily or 50 mg three times daily). Based on efficacy and tolerability, dose may be increased to 300 mg daily after one week. Maximum recommended dose is 600 mg daily for neuropathic pain and 450 mg daily for fibromyalgia. For renal impairment, adjust dosage according to creatinine clearance: CrCl 30-60 mL/min: maximum 300 mg daily; CrCl 15-30 mL/min: maximum 150 mg daily; CrCl <15 mL/min: maximum 75 mg daily. Administer with or without food. Swallow capsules whole; do not crush or chew. For oral solution, use calibrated measuring device.

Precautions

Monitor for emergence or worsening of depression, suicidal thoughts or behavior, and unusual changes in mood or behavior. Assess renal function before initiation and periodically during treatment. Use with caution in patients with history of angioedema. May cause dizziness and somnolence; advise patients against operating machinery until drug effects are known. Gradual discontinuation recommended over at least one week to minimize withdrawal symptoms. May cause weight gain and peripheral edema; monitor body weight. Visual field testing recommended for patients reporting visual disturbances.

Contraindications

Hypersensitivity to pregabalin or any component of the formulation. Concomitant use with thiazolidinedione antidiabetic agents due to increased risk of peripheral edema and weight gain. Severe renal impairment (CrCl <15 mL/min) without appropriate dose adjustment. History of angioedema with previous pregabalin use. Patients with predisposition to fluid retention or heart failure requiring careful risk-benefit assessment.

Possible side effect

Most common adverse reactions (≥5% and twice placebo) include: dizziness (29%), somnolence (22%), dry mouth (11%), peripheral edema (11%), blurred vision (8%), weight gain (7%), and thinking abnormal (6%). Serious adverse reactions include angioedema, hypersensitivity reactions, suicidal behavior and ideation, peripheral edema, dizziness and somnolence, visual disturbances, and withdrawal symptoms. Laboratory abnormalities may include elevated creatine kinase, decreased platelet count, and PR interval prolongation.

Drug interaction

Opioids: Enhanced sedative effects and respiratory depression. Benzodiazepines: Additive CNS depression. Alcohol: Potentiated cognitive and motor impairment. Angiotensin-converting enzyme inhibitors: Increased risk of angioedema. Thiazolidinediones: Exacerbated fluid retention and weight gain. CNS depressants: Enhanced sedative effects. No significant interactions with cytochrome P450 substrates, inhibitors, or inducers.

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed dose. Maintain regular dosing schedule to ensure stable plasma concentrations. If multiple doses are missed, contact healthcare provider for dose re-titration instructions to minimize withdrawal symptoms.

Overdose

Symptoms may include profound sedation, confusion, restlessness, agitation, depression, and seizures. Management includes supportive care with maintenance of airway and vital signs. Hemodialysis effectively removes pregabalin (50% reduction in plasma levels over 4 hours). Consider gastric lavage if presented within 1 hour of ingestion. No specific antidote exists. Monitor for respiratory depression, particularly with concomitant CNS depressants.

Storage

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Keep container tightly closed and protect from moisture. Dispense in original container with child-resistant closure. Oral solution: Store at room temperature; do not freeze. Discard any unused portion after 90 days of first opening the bottle. Keep out of reach of children and pets.

Disclaimer

This information does not replace professional medical advice. Consult healthcare provider for diagnosis and treatment decisions. Dosage adjustments should only be made under medical supervision. Report any adverse reactions to healthcare provider immediately. Not all possible uses, precautions, or interactions are listed here.

Reviews

Clinical trials demonstrate 50% pain reduction in 40% of neuropathic pain patients versus 15% with placebo. Systematic reviews show number needed to treat (NNT) of 5.2 for 50% pain reduction in diabetic neuropathy. Fibromyalgia studies report 30% pain reduction in 48% of patients versus 27% with placebo. Long-term studies maintain efficacy over 52 weeks with consistent safety profile. Patient-reported outcomes indicate significant improvements in sleep quality, mood, and quality of life measures.