Lyrica: 12 Things You Need to Know
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Oct 1, 2020.
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:
- nerve pain associated with diabetic neuropathy
- pain from shingles (herpes zoster)
- nerve pain from 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. Generic versions of Lyrica capsules and oral solution are now available for prescription cost-savings; however, the oral solution may not yet be at the pharmacy.
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.
- A generic formulation of Lyrica CR (the long-acting form) is not yet available.
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 adults. 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 component of therapy. Your doctor will evaluate your dose on a regular basis and will track your seizure activity.
- In general, total Lyrica (pregabalin) doses between 150 to 600 mg per day (divided in 2 or 3 doses) are effective for add-on therapy in the treatment of partial onset seizures in adults.
- Higher doses may result in more side effects.
- The maximum adult dose is 600 mg per day in divided doses.
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 (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.
- 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.
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 is approved to treat the pain that may occur after a case of shingles clears up (postherpetic neuralgia).
- Begin the Lyrica (pregabalin, immediate-release) dose at 75 mg two times a day or 50 mg three times a day (150 mg/day).
- Your doctor may increase your dose to 300 mg/day within 1 week if needed and if you are tolerating the drug.
- Reduced doses are also needed in 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 reposnd and your side effects.
- 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 the long-acting form, Lyrica CR, at all.
Common Side Effects: Lyrica and Lyrica CR
As with most drugs, Lyrica (pregabalin) has side effects. Lyrica has been associated with:
- Lack of coordination (ataxia)
- Weight gain
- Dry mouth
- Blurred vision
- Swelling of hands or feet
Lyrica is also classified as a schedule V controlled substance because there have been reports of euphoria, improved happiness, excitement, or calmness, and a "high" similar to marijuana.
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 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. 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.
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 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, if you suddenly stop taking this medication, unpleasant side effects may kick in.
With Lyrica (pregabalin) these effects may include:
- upset stomach or nausea
- trouble sleeping
- increased sweating
- anxious feeling.
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 to screen for interactions with new medications.
In Dec. 2019, the FDA warned that serious breathing difficulties may occur in patients using pregabalin (Lyrica, Lyrica CR). This includes opioid pain medicines, other drugs that depress the central nervous system, and conditions such as chronic obstructive pulmonary disease (COPD) that reduce lung function. The elderly are also at higher risk.
- Any drug that makes you sleepy, such as narcotic painkillers like hydrocodone or oxycodone, or medicines for anxiety like lorazepam (Ativan), or antidepressant may further increase the risk for trouble breathing, sleepiness, 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.
The use of 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 medicines you take, including vitamins or herbal supplements.
Cost-Savings: Lyrica Is Now Generically Available
Let's face it -- brand name drugs can be expensive.
- Prices have dropped signifcantly, and while prices vary between pharmacies and based on your dose, you can expect to pay roughly $15 to $50 cash for a 30-day supply using an online prescription card; but prices vary.
- It may be even less expensive if you have a private insurance, Medicare or Medicaid copay.
- Generic prices compare to roughly $500 to $700 if you buy the brand name drug and pay cash with a coupon.
- Ask your pharmacist about the generic option, and how you can best save.
The longer acting, brand name Lyrica CR was approved in 2017 and generics for the long-acting form will not be available for many years.
Finished: Lyrica: 12 Things You Need to Know
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