pregabalin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
pregabalin: clinical details
Prescribing considerations
- Confirm the licensed indication for the formulation; prolonged-release Misabri PR is licensed only for adult neuropathic pain.
- Assess renal function and review respiratory or neurological disease, older age and concurrent CNS depressants.
- Assess substance misuse, dependence and significant mental-health history; agree an individual discontinuation strategy.
- Use caution in cardiovascularly compromised older adults because peripheral oedema and congestive heart failure have been reported.
- Consider falls risk and effects on alertness, vision, coordination and cognition.
Contraindications and cautions
- Hypersensitivity to pregabalin or any product excipient.
Monitoring
- Renal function and formulation suitability
- Sedation, cognition, coordination, falls and respiratory status
- Mood, suicidal thinking and behavioural change
- Misuse, tolerance, dependence, escalation or withdrawal
- Weight, oedema and blood-glucose control where relevant
- Persistent or significant visual symptoms
- Benefit, adverse effects and continuing need
Clinical pharmacology
Pregabalin binds the alpha-2-delta subunit of voltage-gated calcium channels. It is not protein-bound, undergoes negligible metabolism and is eliminated mainly unchanged in urine; clearance is proportional to creatinine clearance. Routine plasma-concentration monitoring is not generally required.
Formulation and product differences
- Standard-release tablets, capsules and oral solution may be taken with or without food.
- The oral solution contains parabens, includes an oral syringe and bottle adapter, and should be discarded 60 days after opening.
- Lyrica hard capsules contain lactose; check excipient suitability for the individual product.
- Prolonged-release tablets must be taken after an evening meal and swallowed intact; fasting substantially reduces exposure.
- Prolonged-release pregabalin is not recommended in severe renal impairment or haemodialysis; an immediate-release product is required instead.
- Standard-release and prolonged-release products are not directly interchangeable without a prescriber-led conversion plan.
pregabalin preparations and strengths
Capsule
Route: Oral
Strengths: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg
pregabalin interactions
Pregabalin has few metabolic interactions, but additive sedation and respiratory depression are important.
Opioids, including oxycodone
May increase sleepiness, impaired coordination, constipation, respiratory depression, coma and risk of death.
Benzodiazepines and other central nervous system depressants
May increase sedation, confusion, falls and breathing problems.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.