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Pregabalin ER

Class
Anticonvulsants and anxiolytics
Subclass
Gabapentinoids
Substance name
Pregabalin ER
Brand names
Lyrica CR®
Common formulations
Film-coated tablet
See also
Pregabalin (Lyrica®)
Dosage and administration
Adults patients
Neuropathic pain in patients with diabetic neuropathy
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Start at: 165 mg PO daily for 1 week
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Maintenance: 330 mg PO daily
Taken after evening meals. Titrate based on response and tolerability. Taper gradually over at least 1 week when discontinuing.
Postherpetic neuralgia
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Start at: 165 mg PO daily for 1 week
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Maintenance: 330 mg PO daily
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Maximum: 660 mg per day
Taken after evening meals. Titrate based on response and tolerability. Taper gradually over at least 1 week when discontinuing.
Indications for use
Labeled indications
Adults
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Treatment of neuropathic pain in patients with diabetic neuropathy
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Treatment of postherpetic neuralgia
Safety risks
Contraindications
Hypersensitivity to pregabalin or its components
Warnings and precautions
Angioedema
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Use caution in patients with a history of angioedema or taking other drugs associated with angioedema, such as ACEis.
Blurred vision
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Maintain a high level of suspicion, as pregabalin may cause blurred vision.
Decreased platelet count
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Maintain a high level of suspicion, as pregabalin has been associated with an increased risk of thrombocytopenia.
Increased serum CK
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Maintain a high level of suspicion, as pregabalin may cause serum CK elevations.
Peripheral edema
•
Use caution in patients with congestive HF or taking thiazolidinediones.
Prolonged PR interval
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Maintain a high level of suspicion, as pregabalin may cause PR interval prolongation.
Respiratory depression
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Use caution in patients with underlying respiratory impairment or taking CNS depressants, such as opioids.
Seizure
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Do not discontinue abruptly in patients with seizure disorder.
Somnolence
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Use extreme caution in patients performing activities requiring mental alertness, such as driving or operating machinery.
Suicidal ideation
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Maintain a high level of suspicion, as pregabalin has been associated with an increased risk of suicidal behavior and ideation. Monitor closely for depression, suicidality, and unusual changes in behavior.
Weight gain
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Maintain a high level of suspicion, as pregabalin may cause weight gain.
Specific populations
Renal impairment
CrCl > 60 mL/min
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Use acceptable. No dose adjustment required.
CrCl 30-60 mL/min
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Reduce dose by 50%.
CrCl < 30 mL/min
•
Do not use.
Renal replacement therapy
Any modality
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Do not use.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
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Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Enroll patients in a dedicated pregnancy outcome monitoring registry.
Breastfeeding
Do not use during breastfeeding.
Low excretion in breastmilk (5-25%).
Low levels in breastfed infants (5-25%).
May potentially cause adverse effects in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Very common > 10%
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Dizziness, somnolence
Common 1-10%
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Edema, nasopharyngitis, peripheral edema, blurred vision, dry mouth, constipation, diarrhea, diplopia, erectile dysfunction, fatigue, headache, ↑ appetite, fever, ecchymosis, leg cramps, myalgia, muscle weakness, anxiety, behavioral or personality changes, hypertonia, hypoesthesia, ↓ libido, nystagmus, paresthesia, sedation, stupor, muscle twitching, tinnitus, conjunctivitis, anorgasmia, urinary frequency, urinary incontinence, joint swelling, loss of balance, nausea, vertigo, vomiting, weight gain, urinary tract infections
Uncommon < 1%
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Bronchitis, deep vein thrombosis, heart failure, acute pancreatitis, acute otitis media, pneumonia, sciatica, nephritis, gastroenteritis, ↑ serum ALT, ↑ serum AST, cough, arthralgia, palpitations, hypotension, orthostatic hypotension, syncope, periorbital edema, abdominal pain, abdominal distension, dysphagia, tongue swelling, chest pain, anemia, ↑ blood eosinophil count, lymphadenopathy, ↓ WBC count, ↑ WBC count, incoordination, nightmares, agitation, memory impairment, apathy, aphasia, circumoral paresthesia, cognitive impairment, dysarthria, dysgeusia, hallucinations, hostility, hyperesthesia, hyperkinesia, hypokinesia, hypotonia, ↑ libido, myoclonus, sleeping disorder, irritability, ejaculation difficulties, dysuria, hematuria, leukorrhea, low urine output, urinary retention, sinusitis
Rare < 0.1%
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Myelofibrosis, polycythemia, Stevens-Johnson syndrome, tachycardia, facial edema, purpura, ↑ urine glucose, ↑ serum lipase, ↑ urine protein, ↑ blood neutrophil count, altered level of consciousness, bradykinesia, coma, cogwheel rigidity, delirium, delusions, dyskinesia, dystonia, extrapyramidal signs, pulmonary edema
Unknown frequency
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Bullous pemphigoid, breast enlargement, gynecomastia, respiratory depression, bowel obstruction, suicidal ideation, paralytic ileus
Interactions
Drug(s)
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