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Lyrica: 12 Things You Need to Know

Medically reviewed on Dec 13, 2016 by L. Anderson, PharmD

Lyrica: It's Not Just for Seizures Anymore

Lyrica (pregabalin) was originally approved in 2004 as an anticonvulsant. However, today it's probably more widely used to treat fibromyalgia, and nerve pain associated with diabetic neuropathy, shingles (herpes zoster), or spinal cord injury.

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.

Lyrica comes as a capsule in many strengths, and for those that prefer, it also comes as an oral solution.

Lyrica Use in Seizures

Lyrica is used as an add-on therapy to other medications for treatment of partial onset seizures in adults. How does a partial seizure occur? Abnormal electrical 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 component of therapy. Your doctor will evaluate your dose on a regular basis and will track seizure activity. In general, total doses between 150 to 600 mg per day, divided in 2 or 3 doses, are effective for adjunctive therapy in the treatment of partial onset seizures in adults. However, 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.

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

Lyrica 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 was the first drug FDA approved to treat the chronic pain of fibromyalgia. The Lyrica dose, which is given as an oral capsule, usually starts at 75 mg two times a day (150 mg/day). The dose may be increased to 150 mg two times a day (300 mg/day) after 1 week. If you tolerate this dose, but it is still not fully effective, your doctor may decide to increased your dose to 225 mg two times a day (450 mg/day). 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, or 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 is approved to treat the pain after a case of shingles clears up. Begin Lyrica dosing at 75 mg two times a day, or 50 mg three times a day (150 mg per day). Your doctor may increase your dose to 300 mg per day within 1 week if needed and if you are tolerating the drug. Lower doses are needed in kidney impairment.

Common Side Effects Can Happen: Lyrica

As with most drugs, Lyrica has side effects. Lyrica has been associated with:

  • Drowsiness
  • Dizziness
  • Lack of coordination (ataxia)
  • Weight gain
  • Dry mouth
  • Blurred vision
  • Swelling of hands or feet
  • Confusion
Lyrica is also a schedule V controlled substance because there have been reports of euphoria (intense feeling of happiness, excitement) therefore it may have a risk for abuse.

Serious Side Effects: Allergic Reactions

While most serious side effects with Lyrica 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. If you notice swelling of your face, mouth, lips, gums, tongue, throat or neck or if you have any trouble breathing or have a rash, hives or blisters, you may be having an allergic reaction that requires immediate care.

Patients or caregivers should stop Lyrica and call the doctor or 911 right away if you notice 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. Lyrica can lead to thoughts or actions of suicide in about 1 in 500 people. Changes in mood or behavior may include worsened depression, anxiety, restlessness, trouble sleeping, panic attacks, anger, irritability, agitation, aggression, dangerous impulses or violence, or extreme increases in activity or talking. 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.

Don't Stop Lyrica Cold Turkey

Other than if you have a severe allergic reaction, you should not abruptly stop taking Lyrica. Why is this? With many medications, especially those that work in the brain, if you suddenly stop taking the medication, side effects may kick in. With Lyrica, these effects may include headaches, upset stomach or nausea, diarrhea, trouble sleeping, increased sweating, or anxious feeling. If you have epilepsy, you may have seizures more often. Talk to your doctor before you decide to stop taking Lyrica. If treatment must be stopped, your doctor may slowly discontinue (taper) your medication dose over a period of time, usually at least a week.

Lyrica: Keep an Eye on These Drug Interactions

There is a possibility of drug interactions with Lyrica. The use of an angiotensin converting enzyme (ACE) inhibitor - for example, lisinopril - may increase the chance for swelling and hives. Any drug that makes you sleepy, for example, narcotic painkillers like hydrocodone or oxycodone, or medicines for anxiety like lorazepam (Ativan), may further increase the risk for sleepiness or dizziness. You should not drive if you are combining these types of medications. Certain diabetes drugs like rosiglitazone or pioglitazone may lead to weight gain or swelling. Tell your doctor and pharmacist about all the medicines, vitamins or herbal supplements you take.

When Will Lyrica Go Generic?

Let's face it - brand name drugs can be expensive. But the generic for Pfizer's Lyrica - pregbablin - won't be available until around December 2018. The FDA has tentatively approved many generic versions, but they can't be marketed yet. A court case in 2014 blocked the marketing of the generic formulation. Lyrica is an important revenue generator for Pfizer's portfolio, particularly after they lost their patent on mega-blockbuster Lipitor.

According to The Statistics Portal, sales of Lyrica topped $4.8 billion in 2015, making it Pfizer’s second biggest selling product.

Finished: Lyrica: 12 Things You Need to Know

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Sources

  • Lyrica (Pregabalin) Capsules Drug Approval Package. Drugs@FDA Accessed 12/13/2016 http://www.accessdata.fda.gov/drugsatfda_docs/nda/2004/021446_LyricaTOC.cfm
  • Lyrica (pregabalin) [Package Insert] Parke-Davis Div of Pfizer Inc Revised: 03/2016. Accessed 12/13/2016 at https://www.drugs.com/pro/lyrica.html
  • Lyrica (pregabalin). Pfizer Consumer Information 2015. Accessed 12/13/2016 http://www.lyrica.com/Fibromyalgia/fibromyalgia-introduction
  • Decker S. Pfizer Wins Ruling to Block Generic Lyrica Until 2018. Bloomberg Business. February 7, 2014. Accessed 12/13/2016 at http://www.bloomberg.com/news/articles/2014-02-06/pfizer-wins-ruling-to-block-generic-lyrica-until-2018
  • Pfizer's top 10 products based on revenue in 2015 (in million U.S. dollars). 2016 The Statistics Portal. Accessed 12/13/2016 http://www.statista.com/statistics/253788/pfizers-top-products-based-on-revenues/
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