Pregabalin (Lyrica)

Class

Anticonvulsant, GABA analog

Mechanism

Binds to alpha-2-delta subunit of voltage-gated calcium channels, decreasing excitatory neurotransmitter release

FDA-Approved Use

Partial seizures, neuropathic pain (including diabetic neuropathy and postherpetic neuralgia), fibromyalgia

Off-Label Use

Generalized anxiety disorder (GAD), alcohol use disorder (AUD) including withdrawal symptoms, chronic pain syndromes (including neuropathic pain related to multiple sclerosis [MS]), restless legs syndrome (RLS), bipolar disorder augmentation, social anxiety disorder, post-traumatic stress disorder (PTSD), and certain off-label psychiatric symptom management such as agitation or anxiety in neurodegenerative diseases

Formulation

Oral capsules, oral solution

Titration

75 mg p.o. twice daily, titrated as clinically indicated

Dose Range

150–600 mg/day divided doses

Kinetics

Renally excreted unchanged; half-life ~6 hours; dose adjustment needed in renal impairment

Common AEs

Dizziness, somnolence, peripheral edema, dry mouth, weight gain

Serious/Rare AEs

Respiratory depression (especially with CNS depressants), hypersensitivity reactions (angioedema, rash)

Monitoring

Monitor for misuse or abuse; assess respiratory status in high-risk populations

Black Box Warning

None

Considerations

Pregabalin may be beneficial in neuropathic pain syndromes, including those related to MS. Caution is advised in elderly patients and those with respiratory compromise. Use in patients with neurodegenerative disease–related behavioral symptoms or agitation is sometimes considered, though evidence remains limited. Dose adjustments are required for renal impairment.