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Lyrica: 12 Things You Need to Know

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Sep 22, 2021.

Lyrica: It's Not Just for Seizures Anymore

Lyrica (pregabalin) was originally approved in 2004 as an anticonvulsant.

Today it's also widely used to treat:

Lyrica works by slowing down impulses in the brain that cause seizures. It also affects neurotransmitters (chemicals) in the brain that send pain signals across the nervous system.

In October 2017 the FDA also approved Lyrica CR extended-release tablets as a once-daily therapy for the management of neuropathic (nerve) pain associated with diabetic peripheral neuropathy and postherpetic neuralgia.

  • Lyrica CR did not receive approval for the management of fibromyalgia and its effectiveness as adjunct therapy for partial onset seizures has not been demonstrated.

Lyrica comes as a capsule in many strengths, and for those that prefer, it also comes as an oral solution. Generic versions of Lyrica and Lyrica CR are now available and may save you money; ask your pharmacist.

Lyrica Use in Seizures

Immediate-release Lyrica (pregabalin) is used as an add-on therapy to other medications for treatment of partial onset seizures, also called focal seizures, in patients one month of age and older. What is a partial seizure?

Abnormal electrical nerve activity in the brain triggers a seizure. When the electrical activity is confined to just one part of the brain, it is known as a partial onset seizure.

  • In a simple partial seizures, consciousness is not lost, the seizure may only last one minute, and it can affect senses, like how you see, taste, or smell.
  • In complex partial seizures, the overactive nerves occur across the entire brain, and consciousness is lost briefly, almost like a staring spell. You may appear awake and alert, but your brain is not really aware of it's surroundings.

Lyrica Dosing: Partial Onset Seizures

Dosing for any kind of seizure is a very individualized. Your doctor will evaluate your dose on a regular basis and will track your seizure activity.

  • In adults 17 years of age and older, total Lyrica (pregabalin) doses between 150 to 600 mg per day (divided in 2 or 3 doses) are recommended for add-on therapy in the treatment of partial onset seizures. The maximum adult dose is 600 mg per day in divided doses.
  • In children, the recommended daily dose is based on weight and is also divided in 2 or 3 doses (dependent upon age).
  • Higher doses may result in more side effects.

Lyrica is mainly excreted through the kidneys, and your dose for any use may need to be decreased if you have kidney disease. Your doctor will know how to adjust your doses based on a calculation of your kidney function.

The use of Lyrica in children with reduced kidney function has not been studied by the manufacturer.

Lyrica Use in Fibromylagia

Fibromyalgia is thought to be due to overactive nerves due to the imbalance of natural chemicals found in the body.

These nerves send messages throughout the body that may be responsible for the pain and tenderness that occurs in fibromylagia.

Lyrica (pregabalin) is thought to help to "quiet" this pain by calming the overactive nerves, and reducing the excess electrical signals sent by the nerves.

Lyrica (pregabalin) Dosing: Fibromylagia

If you have fibromyalgia, you know it can cause muscle and joint pain almost anywhere in the body, and lead to sensitive areas where pressure is painful.

Lyrica (pregabalin) was the first drug FDA approved to treat the chronic pain of fibromyalgia.

  • The Lyrica dose, given as an oral capsule, usually starts at 75 mg two times a day. It is used for adults.
  • The dose may be increased to 150 mg two times a day after 1 week, and further titrated to 225 mg orally twice a day, if needed.
  • The maximun dose is 450 mg per day in divided doses.

Lyrica was studied at higher doses, but no added effect was seen, and higher doses may not be tolerated as well as the lower dose.

As with other uses, if you have kidney problems, your dose may need to be lowered.

Pain After Shingles: It Hurts

Who knew chickenpox could cause such an extra painful illness? Herpes zoster, also called shingles, results from activation of a virus that stays in your nerves following chickenpox. Shingles causes painful fluid-filled blisters on your skin. About 1 in 5 people who get shingles will also have severe, long-lasting pain afterwards, called postherpetic neuralgia.

Lyrica (pregabalin, immediate-release) is approved to treat the nerve pain that may occur after a case of shingles clears up (postherpetic neuralgia).

  • The Lyrica dose begins at 75 mg two times a day or 50 mg three times a day (150 mg/day). You must have a kidney function (creatinine clearance) of at least 60 mL/min, which your doctor will determine.
  • Your doctor may increase your dose if needed and you are tolerating the medicine.
  • Reduced doses are needed at certain levels of kidney impairment.

The long-acting form, Lyrica CR, is also approved for shingles pain.

  • Doses are usually started at 165 mg once daily and increased to 330 mg once daily within 1 week based on how you respond and your side effects. Take your dose after an evening meal.
  • Your doctor can determine if you need to increase your dose and how quickly.
  • At certain levels of kidney impairment you may not be able to use Lyrica CR at all.

Common Side Effects: Lyrica and Lyrica CR

As with most drugs, Lyrica (pregabalin) has side effects. In adults, Lyrica has been associated with:

  • Drowsiness
  • Dizziness
  • Lack of coordination (ataxia)
  • Weight gain
  • Dry mouth
  • Blurred vision
  • Swelling of hands or feet, edema
  • Confusion
  • Trouble concentrating

In children being treated for seizures, the most common Lyrica side effects are increased appetite and increased weight.

Lyrica is also classified as a schedule V controlled substance because there have been reports of euphoria (excitement, happiness) in up to 12% of patients in reports.

Lyrica CR has similar side effects as seen with Lyrica.

Serious Side Effects: Lyrica Allergic Reactions

While most serious side effects with Lyrica (pregabalin) occur in only a very small number of people, it is important you are aware of them.

Serious, possibly life-threatening allergic reactions like angioedema or allergic reactions can occur with Lyrica or Lyrica CR. You may be having an allergic reaction that requires immediate care if you notice:

  • swelling of your face, mouth, lips, gums, tongue, throat or neck
  • you are having trouble breathing
  • you have a rash, hives or blisters.

Patients or caregivers should stop the use of Lyrica or Lyrica CR if you see any of these symptoms AND call the doctor or 911 immediately if you suspect any serious allergic reactions.

Serious Side Effects: Suicidal Thoughts or Actions

Another uncommon but important side effect is suicidal thoughts or actions in patients taking any seizure medication - including Lyrica and Lyrica CR.

Lyrica (generic name: pregablin) can lead to thoughts or actions of suicide in about 1 in 500 people. Patients, family members or caregivers should call the doctor right away if they notice behavioral changes, suicidal thoughts or actions, or thoughts or evidence of self harm.

Changes in mood or behavior may include:

  • worsened depression
  • anxiety, restlessness, trouble sleeping
  • panic attacks
  • anger, irritability, agitation, aggression
  • dangerous impulses or violence
  • extreme increases in activity or talking.

If you or a dependent have suicidal thoughts or actions, do not stop taking Lyrica without first talking to a healthcare provider.

Don't Stop Lyrica Cold Turkey

Other than if you are having a severe, life-threatening allergic reaction, you should not abruptly stop taking Lyrica or Lyrica CR (or unless otherwise directed by your doctor). Why is this?

With many medications, especially those that work in the brain, suddenly stopping the medicine may lead to unpleasant side effects.

With Lyrica (pregabalin) these effects may include:

  • headaches
  • upset stomach or nausea
  • diarrhea
  • trouble sleeping
  • increased sweating
  • feeling anxious

If you have epilepsy, you may also have seizures more often.

Talk to your doctor before you decide to stop taking Lyrica. If treatment must be stopped, your doctor will slowly discontinue (taper) your medication dose over a period of time, usually at least a week, to lower the risk of withdrawal side effects.

Drug Interactions, Warnings and Breathing Problems

There is a possibility of drug interactions with Lyrica; be sure a healthcare provider looks for interactions with any new medication you start.

Tell your doctor if you take any of these medicines:

  • Any drug that makes you sleepy, such as narcotic painkillers hydrocodone or oxycodone, or medicines for anxiety like lorazepam, drugs used for sleep like zolpidem, or an antidepressant may further increase the risk for trouble breathing, sleepiness, and dizziness when taken with Lyrica or Lyrica CR.
  • You should not drive if you are combining these types of medications. Don't forget, some over-the-counter medications -- like certain antihistamines -- can cause drowsiness, too.
  • Certain diabetes drugs -- like rosiglitazone (Avandia) or pioglitazone (Actos), which may lead to weight gain or swelling.
  • An angiotensin converting enzyme (ACE) inhibitor (for example: lisinopril), may increase the chance for swelling and hives.

There are many other interactions and warnings with pregabalin. Tell your doctor and pharmacist about all the prescription and non-prescription (OTC) medicines you take, including vitamins or herbal supplements.

Cost-Savings: Generics for Lyrica and Lyrica CR

Let's face it -- brand name drugs can be expensive. But the generics known by the name of pregabalin (Lyrica) and pregabalin extended-release (Lyrica CR) -- are now available at the pharmacy.

  • Prices have dropped significantly and your insurance is most likely to cover the generic option now, although you may still have a copay.
  • If you are paying the full cash price without insurance, using an online prescription coupon to save money.
  • Tell your doctor and pharmacist if you prefer generic medicines.

Finished: Lyrica: 12 Things You Need to Know

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Sources

  • Lyrica (pregabalin) [Package Insert]. Pfizer Inc. New York, NY. Revised: 4/2020. Accessed Sept. 23, 2021 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021446s040,%20022488s017lbl.pdf
  • Lyrica CR (pregabalin extended-release) [Package Insert]. Pfizer Inc. New York, NY. Revised: 4/2020. Accessed Sept. 23, 2021 athttps://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=209501
  • FDA Warns About Serious Breathing Problems with Seizure and Nerve Pain Medicines Gabapentin (Neurontin, Gralise, Horizant) and Pregabalin (Lyrica, Lyrica CR) in Patients with Respiratory Risk Factors. US Food and Drug Administration (FDA). Accessed Sept. 23, 2021 at https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin
  • U.S. FDA approves Lyrica CR (pregabalin) extended-release tablets CV [news release]. New York, NY: Pfizer Inc. Accessed Sept. 23, 2021 at pfizer.com/news/press-release/press-release-detail/u_s_fda_approves_lyrica_cr_pregabalin_extended_release_tablets_cv
  • The top 15 drug patent expirations of 2018. FiercePharma. Accessed Sept. 23, 2021 at https://www.fiercepharma.com/special-report/lyrica-1
  • Pfizer. Medical Information. Accessed Sept. 23, 2021 at https://www.pfizermedicalinformation.com/en-us/lyrica-cr/drug-abuse

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.