Pregabalin
Class: anticonvulsant – gabapentinoid
Indications (NB some may be unlicensed): neuropathic pain, anxiety, focal seizures, pruritis, sweating, hot flushes, refractory hiccup, restless legs syndrome, spasticity, refractory cough (PCF8)
Contraindications/cautions: renal disease (reduce dose – see below)
Adverse reactions: common: dizziness, somnolence, blurred vision, fatigue, dry mouth, headache, tremor, constipation, nausea; less common: weight gain, ataxia, confusion, suicidal thoughts
Metabolism/clearance: not metabolised, mainly excreted unchanged by the kidneys (fraction excreted unchanged by the kidney = 0.9) so adjust dose in renal dysfunction
Interactions:
- additive CNS depression with other CNS depressants e.g. benzodiazepines (e.g. lorazepam), phenothiazines (e.g. chlorpromazine), tricyclic antidepressants (e.g. amitriptyline), opioids, alcohol
| Dosing: | ||
|---|---|---|
| oral: | neuropathic pain/epilepsy | 150 to 600 mg/day in 2 divided doses (start with lower dose 75 mg twice daily and increase) |
| subcut: | not available | |
| rectal: | not available |
Syringe driver: not available
Mechanism of action: may act through effects on calcium channels in the CNS and reduces release of the neurotransmitters glutamate, noradrenaline and substance P
Notes:
- reduce dose in renal impairment:
- CrCl> 60 mL/min – starting dose 75 mg bd; maximum dose 300 mg bd
- CrCl 31 to 60 mL/min – starting dose 25 mg tds; maximum 150 mg bd
- CrCl 15 to 30 mL/min – starting dose 25 to 50 mg od; maximum 150 mg once daily
- CrCl 15 mL/min – starting dose 25 mg od; maximum 75 mg once daily (PCF8)
- if stopping, withdraw dose gradually (over weeks)