Drug Interactions between cinacalcet and Lyrica

Food can enhance the levels of cinacalcet in your body. Cinacalcet should be taken just after eating food. Do not take it on an empty stomach. This will make it easier for your body to absorb the medication. Do not crush, chew, or break the tablets. Swallow them whole.

Alcohol can increase the nervous system side effects of pregabalin such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with pregabalin. Do not use more than the recommended dose of pregabalin, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Anxiolytic, sedative, and hypnotic agents have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use of excessive dosages, and abrupt cessation and/or a reduction in dosage may precipitate withdrawal symptoms. In patients who have developed tolerance, overdosage can still produce respiratory depression and death. Therapy with anxiolytic, sedative, and hypnotic agents should be administered cautiously and for as brief a period as possible. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance or medical supervision when treated with these agents. In addition, it may be prudent to refrain from dispensing large quantities of medication to such patients. After prolonged use or if dependency is suspected, withdrawal of medication should be undertaken gradually using a dosage-tapering schedule.

Pregabalin should be administered cautiously in patients with preexisting conduction abnormalities (e.g., marked first-degree AV block or second- or third-degree AV block), as it has been associated with PR interval prolongation. In a clinical trial, the mean PR interval increase was 3 to 6 msec with pregabalin at doses higher than or equal to 300 mg per day. This mean change difference was not associated with an increased risk of PR increase >=25% from baseline, an increased percentage of subjects with on-treatment PR >200 msec, or an increased risk of adverse reactions of second or third degree AV block. Subgroup analyses did not identify an increased risk of PR prolongation in patients with baseline PR prolongation or in patients taking other PR prolonging medications. However, these analyses cannot be considered definitive because of the limited number of patients in these categories.

Angioedema has been reported during pregabalin therapy, including reports of life-threatening angioedema with respiratory compromise requiring emergency treatment. Therapy with pregabalin should be administered cautiously in patients at risk of developing angioedema or those with a previous episode of angioedema.

Pregabalin treatment may cause peripheral edema. There are limited data concerning the use of pregabalin in patients with congestive heart failure. Therapy with pregabalin should be administered cautiously in patients with New York Heart Association (NYHA) Class III or IV cardiac status.

Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders; phentermine-topiramate should be avoided in patients with history of suicidal attempts or active suicidal ideation. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.

Pregabalin should be administered cautiously in patients with preexisting conduction abnormalities (e.g., marked first-degree AV block or second- or third-degree AV block), as it has been associated with PR interval prolongation. In a clinical trial, the mean PR interval increase was 3 to 6 msec with pregabalin at doses higher than or equal to 300 mg per day. This mean change difference was not associated with an increased risk of PR increase >=25% from baseline, an increased percentage of subjects with on-treatment PR >200 msec, or an increased risk of adverse reactions of second or third degree AV block. Subgroup analyses did not identify an increased risk of PR prolongation in patients with baseline PR prolongation or in patients taking other PR prolonging medications. However, these analyses cannot be considered definitive because of the limited number of patients in these categories.

Postmarketing safety surveillance studies have reported cases of hypotension, worsening heart failure and/or arrhythmias in patients with impaired cardiac function receiving cinacalcet. A causal relationship could not been excluded and this may be mediated by reductions in serum calcium. Cinacalcet should be used with caution in patients with hypotension or preexisting impaired cardiac function.

Cinacalcet lowers serum calcium, and therefore patients should be carefully monitored for the occurrence of hypocalcemia. Potential manifestations of hypocalcemia include paresthesias, myalgias, cramping, tetany, and convulsions. Cinacalcet treatment should not be initiated if serum calcium is less than the lower limit of the normal range (8.4 mg/dL). Monitor serum calcium 1 week after treatment initiation or dose adjustment, and once every month once the maintenance dose has been established.

Postmarketing safety surveillance studies have reported cases of hypotension, worsening heart failure and/or arrhythmias in patients with impaired cardiac function receiving cinacalcet. A causal relationship could not been excluded and this may be mediated by reductions in serum calcium. Cinacalcet should be used with caution in patients with hypotension or preexisting impaired cardiac function.

The use of pregabalin has been associated with creatine kinase elevations. Use caution when treating patients with diagnosed of suspected myopathy or with significantly elevated creatine kinase levels.

Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders; phentermine-topiramate should be avoided in patients with history of suicidal attempts or active suicidal ideation. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.

Cinacalcet may lower seizure threshold in patients with a history of seizures. Serum calcium levels should be closely monitored in patients receiving cinacalcet, particularly in patients with history of seizure disorders.