Pregabalin (US brand name Lyrica®) is a medication that is approved in Europe for the treatment of generalized anxiety disorder, though not in the US. But, even in the US, it is often used off-label for the treatment of anxiety and, sometimes, difficult-to-treat insomnia.
On this page, we present some basic information about this medication. Other articles on this website with more advanced information and tips related to this medication are linked to under Related Pages below.
Pregabalin is approved by the European Medicines Agency (EMA) for the treatment of generalized anxiety disorder (GAD).
As of May 2021, in the United States, pregabalin does not have an FDA indication for any mental disorder.
Its FDA indications are for:
– Neuropathic pain associated with diabetic peripheral neuropathy (DPN)
– Postherpetic neuralgia (PHN)
– Adjunctive therapy for the treatment of partial-onset seizures in patients 1 month of age and older
– Neuropathic pain associated with spinal cord injury
Mechanism of Action/Pharmacodynamics
GABA (gamma-aminobutyric acid) is the most widespread inhibitory neurotransmitter in the brain. Many medications work directly or indirectly by increasing GABA-related activity.
The exact mechanism of action of pregabalin is not known.
– It is structurally similar to GABA, but it is not a precursor of GABA and does not have any activity at GABA receptors.
– Pregabalin does not affect monoamine neurotransmitters like serotonin, norepinephrine, or dopamine.
– It binds to the alpha-2-delta subunits of voltage-gated calcium channels in the central nervous system.
Pregabalin is eliminated largely by the kidney.
It has an elimination half-life of about 6 hours.
Warnings and Precautions
Watch for development of angioedema, hypersensitivity, increased suicidal thoughts or behaviors, respiratory depression, dizziness and somnolence, and peripheral edema.
Potential side effects
Please see THIS PAGE for a handout listing both the common and less common side effects of this medication along with the percentages of patients who report them.
Pregabalin 150-600 mg/day in divided doses may be given for generalized anxiety disorder (GAD).
Starting: 150 mg/day in 2 to 3 divided doses
After week 1: 300 mg/day in 2 to 3 divided doses
After week 2: 450 mg/day in 2 to 3 divided doses
After week 3: Maximum dose of 600 mg/day in 2 to 3 divided doses
Dosage forms and strengths
Capsules: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, and 300 mg
Oral Solution: 20 mg/mL
Important! Please refer to the full Prescribing Information (see link below) before prescribing this medication.
Pregabalin (Lyrica®) for generalized anxiety disorder (GAD) with partial response to a serotonergic antidepressant?
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