Lyrica

Generic name: pregabalin
Brand names: Lyrica, Lyrica CR
Drug class: Gamma-aminobutyric acid analogs

Medically reviewed by A Ras MD.

What is Lyrica?

Lyrica is a prescription medicine used in adults, 18 years of age and older to treat pain from damaged nerves (neuropathic pain) that happens with diabetes.

It is also used to treat pain from damaged nerves (neuropathic pain) that follows healing of shingles, fibromyalgia (pain all over your body), and pain from damaged nerves (neuropathic pain) that follows spinal cord injury

It is not known if Lyrica is safe and effective in people under 18 years of age for the treatment of fibromyalgia and neuropathic pain with diabetes, shingles, or spinal cord injury.

Lyrica is a prescription medicine used in people 1 month of age and older to treat partial-onset seizures when taken together with other seizure medicines.

For the treatment of partial-onset seizures when taken together with other seizure medicines, it is not known if Lyrica is safe and effective in children under 1 month of age.

Description

LYRICA CR (pregabalin extended-release) tablets are for oral use and contain pregabalin. Pregabalin is described chemically as (S)-3-(aminomethyl)-5-methylhexanoic acid. The molecular formula is C8H17NO2 and the molecular weight is 159.23. The chemical structure of pregabalin is:

Pregabalin is a white to off-white, crystalline solid with a pKa1 of 4.2 and a pKa2 of 10.6. It is freely soluble in water and both basic and acidic aqueous solutions. The log of the partition coefficient (n-octanol/0.05M phosphate buffer) at pH 7.4 is – 1.35.

LYRICA CR extended-release tablets are administered orally and contain 82.5, 165, or 330 mg of pregabalin, along with Kollidon SR (polyvinyl acetate, povidone, sodium lauryl sulphate, and silica), crospovidone, polyethylene oxide, carbomer, magnesium stearate, polyvinyl alcohol, titanium dioxide, talc, polyethylene glycol, and colorants as inactive ingredients.

Mechanism of Action

Pregabalin binds with high affinity to the alpha2-delta site (an auxiliary subunit of voltage-gated calcium channels) in central nervous system tissues. Although the mechanism of action of pregabalin has not been fully elucidated, results with genetically modified mice and with compounds structurally related to pregabalin (such as gabapentin) suggest that binding to the alpha2-delta subunit may be involved in pregabalin’s anti-nociceptive and antiseizure effects in animals. In animal models of nerve damage, pregabalin has been shown to reduce calcium-dependent release of pro-nociceptive neurotransmitters in the spinal cord, possibly by disrupting alpha2-delta containing-calcium channel trafficking and/or reducing calcium currents. Evidence from other animal models of nerve damage and persistent pain suggest the anti-nociceptive activities of pregabalin may also be mediated through interactions with descending noradrenergic and serotonergic pathways originating from the brainstem that modulate pain transmission in the spinal cord.

While pregabalin is a structural derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), it does not bind directly to GABAA, GABAB, or benzodiazepine receptors, does not augment GABAA responses in cultured neurons, does not alter rat brain GABA concentration or have acute effects on GABA uptake or degradation. However, in cultured neurons prolonged application of pregabalin increases the density of GABA transporter protein and increases the rate of functional GABA transport. Pregabalin does not block sodium channels, is not active at opiate receptors, and does not alter cyclooxygenase enzyme activity. It is inactive at serotonin and dopamine receptors and does not inhibit dopamine, serotonin, or noradrenaline reuptake.

What is the most important information I should know about Lyrica?

Lyrica may cause serious side effects including:

serious, even life-threatening, allergic reactions
suicidal thoughts or actions
serious breathing problems
swelling of your hands, legs and feet
dizziness and sleepiness

These serious side effects are described below:

Serious, even life-threatening, allergic reactions.
Stop taking Lyrica and call your healthcare provider right away if you have any of these signs of a serious allergic reaction:
- swelling of your face, mouth, lips, gums, tongue, throat or neck
- trouble breathing
- rash, hives (raised bumps) or blisters
Like other antiepileptic drugs, Lyrica may cause suicidal thoughts or actions in a very small number of people, about 1 in 500. Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:
- thoughts about suicide or dying
- attempts to commit suicide
- new or worse depression
- new or worse anxiety
- feeling agitated or restless
- panic attacks
- trouble sleeping (insomnia)
- new or worse irritability
- acting aggressive, being angry, or violent
- acting on dangerous impulses
- an extreme increase in activity and talking (mania)
- other unusual changes in behavior or moodIf you have suicidal thoughts or actions, do not stop Lyrica without first talking to a healthcare provider.
- Stopping Lyrica suddenly can cause serious problems.
- Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.How can I watch for early symptoms of suicidal thoughts and actions?
- Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings.
- Keep all follow-up visits with your healthcare provider as scheduled.
- Call your healthcare provider between visits as needed, especially if you are worried about symptoms.
Serious breathing problems can occur when Lyrica is taken with other medicines that can cause severe sleepiness or decreased awareness, or when it is taken by someone who already has breathing problems. Watch for increased sleepiness or decreased breathing when starting Lyrica or when the dose is increased. Get help right away if breathing problems occur.
Swelling of your hands, legs and feet. This swelling can be a serious problem for people with heart problems.
Dizziness and sleepiness. Do not drive a car, work with machines, or do other dangerous activities until you know how Lyrica affects you. Ask your healthcare provider about when it will be okay to do these activities.

Who should not take Lyrica?

Do not take Lyrica if you are allergic to pregabalin or any of the ingredients in Lyrica.

See “What is the most important information I should know about Lyrica?” above for the signs of an allergic reaction.

See the end of this Medication Guide for a complete list of ingredients in Lyrica.

What should I tell my healthcare provider before taking Lyrica?

Before taking Lyrica, tell your healthcare provider about all your medical conditions, including if you:

have or have had depression, mood problems or suicidal thoughts or behavior.
have kidney problems or get kidney dialysis.
have heart problems including heart failure.
have a bleeding problem or a low blood platelet count.
have abused prescription medicines, street drugs, or alcohol in the past.
have ever had swelling of your face, mouth, tongue, lips, gums, neck, or throat (angioedema).
plan to father a child. Animal studies have shown that pregabalin, the active ingredient in Lyrica, made male animals less fertile and caused sperm to change. Also, in animal studies, birth defects were seen in the offspring (babies) of male animals treated with pregabalin. It is not known if these problems can happen in people who take Lyrica.
are pregnant or plan to become pregnant. Lyrica may harm your unborn baby. You and your healthcare provider will decide if you should take Lyrica while you are pregnant.
- If you become pregnant while taking Lyrica, talk to your healthcare provider about registering with the North American Antiepileptic Drug Pregnancy Registry. You can enroll in this registry by calling 1-888-233-2334. The purpose of this registry is to collect information about the safety of antiepileptic drugs during pregnancy. Information about the registry can also be found at the website, http://www.aedpregnancyregistry.org/.
Are breastfeeding or plan to breastfeed. Lyrica passes into your breast milk. It is not known if Lyrica can harm your baby. Talk to your healthcare provider about the best way to feed your baby if you take Lyrica. Breastfeeding is not recommended while taking Lyrica.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins or herbal supplements. Lyrica and other medicines may affect each other causing side effects.

Especially tell your healthcare provider if you take:

angiotensin converting enzyme (ACE) inhibitors, which are used to treat many conditions, including high blood pressure. You may have a higher chance for swelling and hives if these medicines are taken with Lyrica.
Avandia (rosiglitazone) or Actos (pioglitazone) for diabetes. You may have a higher chance of weight gain or swelling of your hands or feet if these medicines are taken with Lyrica.
any opioid pain medicine (such as oxycodone), or medicines for anxiety (such as lorazepam) or insomnia (such as zolpidem). You may have a higher chance for dizziness, sleepiness or serious breathing problems if these medicines are taken with Lyrica.
any medicines that make you sleepy.

Know the medicines you take. Keep a list of them with you to show your healthcare provider and pharmacist each time you get a new medicine. Do not start a new medicine without talking with your healthcare provider.

How should I take Lyrica?

Take Lyrica exactly as prescribed. Your healthcare provider will tell you how much Lyrica to take and when to take it.
Lyrica may be taken with or without food.
Your healthcare provider may change your dose. Do not change your dose without talking to your healthcare provider.
Do not stop taking Lyrica without talking to your healthcare provider. If you stop taking Lyrica suddenly you may have headaches, nausea, diarrhea, trouble sleeping, increased sweating, or you may feel anxious. If you have epilepsy and you stop taking Lyrica suddenly, you may have seizures more often. Talk with your healthcare provider about how to stop Lyrica slowly.
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, just skip the missed dose. Take the next dose at your regular time. Do not take 2 doses at the same time.
If you take too much Lyrica, call your healthcare provider or poison control center, or go to the nearest emergency room right away.

What should I avoid while taking Lyrica?

Do not drive a car, work with machines, or do other dangerous activities until you know how Lyrica affects you.
Do not drink alcohol while taking Lyrica. Lyrica and alcohol can affect each other and increase side effects such as sleepiness and dizziness.

What are the possible side effects of Lyrica?

Lyrica may cause serious side effects, including:

See “What is the most important information I should know about Lyrica?”
Muscle problems, muscle pain, soreness, or weakness. If you have these symptoms, especially if you feel sick and have a fever, tell your healthcare provider right away.
Problems with your eyesight, including blurry vision. Call your healthcare provider if you have any changes in your eyesight.
Weight gain. If you have diabetes, weight gain may affect the management of your diabetes. Weight gain can also be a serious problem for people with heart problems.
Feeling “high”.

The most common side effects of Lyrica in adults are:

dizziness
blurry vision
dry mouth
weight gain
sleepiness
trouble concentrating
swelling of hands and feet

The most common side effects of Lyrica in children are weight gain, increase in appetite, and sleepiness.

Lyrica caused skin sores in animal studies. Skin sores did not happen in studies in people. If you have diabetes, you should pay attention to your skin while taking Lyrica and tell your healthcare provider about any sores or skin problems.

Tell your healthcare provider about any side effect that bothers you or that does not go away.

These are not all the possible side effects of Lyrica. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of Lyrica

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Lyrica for a condition for which it was not prescribed. Do not give Lyrica to other people, even if they have the same symptoms you have. It may harm them. You can ask your healthcare provider or pharmacist for information about Lyrica that is written for health professionals.

How should I store Lyrica?

Store Lyrica capsules and oral solution at room temperature between 68°F to 77°F (20°C to 25°C) in its original package.
Safely throw away any Lyrica that is out of date or no longer needed.

Keep Lyrica and all medicines out of the reach of children.

What are the ingredients in Lyrica?

Active ingredient: pregabalin

Inactive ingredients:

Capsules: lactose monohydrate, cornstarch, talc

Capsule shell: gelatin and titanium dioxide; Orange capsule shell: red iron oxide; White capsule shell: sodium lauryl sulfate, colloidal silicon dioxide. Colloidal silicon dioxide is a manufacturing aid that may or may not be present in the capsule shells.

Imprinting ink: shellac, black iron oxide, propylene glycol, potassium hydroxide.

Oral solution: methylparaben, propylparaben, monobasic sodium phosphate anhydrous, dibasic sodium phosphate anhydrous, sucralose, artificial strawberry #11545 and purified water.