Pregabalin (Lyrica)

When is pregabalin used ?

Pregabalin is approved as an add-on treatment for partial and secondarily generalized seizures (seizures that begin in a limited area of the brain). It is typically not used in the treatment of primary generalized seizures (those seizures that begin on both sides of the brain at the same time).

Besides its use in epilepsy, when else is pregabalin used ?

Medicines are often useful for more than one purpose. Besides controlling seizures, pregabalin is also approved by the Food and Drug Administration (FDA) to treat a condition called postherpetic neuralgia, which is pain that follows the viral rash commonly known as shingles, and for nerve pain in patients with diabetes who have nerve damage. Pregabalin is also approved in Europe, but not the United States, as treatment for generalized anxiety disorder.

What are the most common side effects of pregabalin ?

Pregabalin is a generally well tolerated drug. However some patients complain of the following symptoms, particularly when first starting the medicine:

  • dizziness
  • imbalance
  • fatigue and sleepiness

Less common side effects include:

  • weakness
  • double or blurred vision
  • trouble concentrating/thinking
  • nausea
  • tremor
  • headache
  • confusion
  • increased appetite and weight gain
  • swelling in the legs
  • euphoria (feeling “high”)

If any of these symptoms persist, or are truly bothersome, call your doctor, but never stop or reduce the medicine on your own. Sometimes the doctor can help with these side effects by changing the prescription:

  • reducing the overall amount of pregabalin
  • changing the amount taken at certain times, such as taking a greater proportion of the pregabalin at bedtime to reduce daytime sleepiness
  • prescribing smaller doses, at more frequent intervals

What are the serious side effects of pregabalin ?

Most people who take pregabalin have no or few mild side effects that typically fade within a short period of time. Pregabalin appears to be an exceptionally safe medicine. Indeed, no life-threatening reactions have been linked to it.

Can pregabalin be taken with other medicines ?

Sometimes one kind of medicine changes the way another kind of medicine works in the body. This is true not only for prescription medicines, but also for over-the-counter medicines at the drug store. These interactions between different products are not a concern with pregabalin. There seem to be no medicines, supplements, herbs, or vitamins that affect or are affected by pregabalin in the body.

Who should not take pregabalin ?

Pregabalin is not effective for two types of generalized seizures called absence and myoclonic seizures. Pregabalin, which is closely related to gabapentin, may even worsen absence and myoclonic seizures, so people with these types of seizures should not take it.

Also, people who are allergic to pregabalin or other ingredients in Lyrica should not take it.

If a woman takes pregabalin during pregnancy, will it hurt the baby ?

The U.S. Food and Drug Administration (FDA) list pregabalin in Pregnancy Category C. This indicates that caution is advised, but the benefits of the medication may outweigh the potential risks. There have been no good scientific studies in women, but studies in animals have shown some harm to the fetus. In general, the risk of birth defects is higher for women who take combinations of seizure medicines during their pregnancy and for women with a family history of birth defects.

All women who are capable of becoming pregnant should take at least 0.4 mg (400 mcg) of the vitamin called folic acid every day because it helps to prevent specific birth defects called Neural Tube Defects. (The most well-known of these is spina bifida, in which the spinal cord is not completely enclosed.) Women with epilepsy should take between 1 and 4 mg of folic acid daily during their reproductive years. If the doctor thinks a woman is at especially high risk, the larger dose of folic acid—4 mg (4000 mcg) per day—may be recommended, beginning before the woman becomes pregnant.

Some babies born to mothers taking antiepileptic medications have had inadequate blood clotting within the first 24 hours after birth. It is often recommended that the mother be given 10 to 20 mg of vitamin K per day during the last month of pregnancy to prevent this problem.

About 20% to 35% of women have seizures more often during pregnancy because of changes in hormones, the mother’s blood volume or changes in how their seizure medicine is handled by the body. Even though this may not apply to pregabalin, the doctor may recommend checking the level of medication in the blood regularly during pregnancy so that the dosage can be adjusted as needed.

It is not yet known how much pregabalin passes into breast milk. Further, how pregabalin affects the baby is unknown. That said, it is strongly felt by neurologists and epileptologists that the benefits of breastfeeding largely outweigh the risks of exposing the baby to antiepileptic medications, including pregabalin. As a matter of fact, the American Academy of Neurology and the American Epilepsy Society both recommend breastfeeding in women with epilepsy.