Lyrica, generic pregabalin, is a new medication that has anti anxiety, anti-pain and anti-convulsive activity. Those effects means it has many uses.
In the United States, Lyrica is approved for partial epilepsy, diabetic neuropathy, postherpetic neuralgia and fibromyalgia. In Europe, it is approved for treating generalized anxiety disorder.
How can it do all that?
On a chemical level, Lyrica is a lot like GABA, which is a neurotransmitter involved in slowing down the activity of certain parts of your brain. More specifically, Lyrica binds to calcium channels and reduces their intake of calcium. Doing so lowers the release of other neurotransmitters like norepinephrine and glutamate, which are involved in anxiety and other processes.
This chemical action is very similar to that exhibited by the benzodiazepines, which are known for high addiction and abuse potential. Because of this similarity, there is the concern that Lyrica can be abused to get high and could possibly be addictive. It seems that this is possible, but to significantly lesser degree than with the benzodiazepines.
Lyrica has been used by some doctors for off-label uses such as treating arthritis. While such use may have benefit, it’s important to note that in 2009 a subsidiary of Pfizer plead guilty to marketing inappropriate uses of Lyrica as part of a major settlement.
Lyrica is typically given at from anywhere from 150mg daily to 600mg daily. Depending on the specific use, the dose may vary.
Use for fibromyalgia
Lyrica was approved in 2007 as a treatment for fibromyalgia, the first medication for that condition.
Patients who take Lyrica for fibromyalgia have reported moderately positive results. On a fibromyalgia pain scale of 1-10, those on it will have roughly a one point reduction in pain compared to those treated with placebo. Roughly 30% of those with Fibromyalgia who use Lyrica will experience a 50% decrease in pain, while only 13% on placebo have such a reduction.
In looking at those numbers, it’s important to remember that, as a condition, fibromyalgia is difficult to treat with very few people reporting significant improvement over time.
Use for diabetic peripheral neuropathy
Lyrica appears to be a solid treatment for diabetic peripheral neuropathy (DPN). According to an independent analysis by the Cochrane review, 50% of patients with DPN and who take Lyrica report significant reduction in pain over time.
But how does that compare to traditional treatment?
The traditional treatment for DPN is amitriptyline, as recommended by the American Diabetic Association, as well as SSRIs and other medications. Lyrica seems to have similar effectiveness but may have different side effects.
For DPN, the optimal dose seems to be around 300mg daily, possibly given over two doses.
Lyrica’s Side effects:
20-30% of people who use this medication stop specifically because of a serious side effect, which is somewhat on the high side for a psychiatric medication. Side effects seem to be dose related with increasing incidence at higher doses.
Most common side effects:
Up to 45% report dizziness
Up to 30% report drowsiness
Up to 20% report ataxia, or issues with smooth movement
Up to 16% report weight gain
Up to 15% report reduced salivation
Up to 10% report constipation
Other possible side effects
Balance issues, euphoric mood, fatigue, pain in the joints, chest pain.
Use of Lyrica may rarely be associated with difficulty paying attention and or concentrating.
There have been reports of tremors associated with this medication and there was a recent case report of an older woman who developed Parkinson’s Disease symptoms most likely due to Lyrica.
This list is not comprehensive; consult manufacturers insert for more.
Lyrica is not metabolized by the traditional enzymes in the liver, which means that it may have fewer drug interactions than most drugs. Roughly 90% of the drug is released in the urine which means both heavy use of kidney and relatively low metabolism by the liver.
This means that kidney impairment may have a significant effect on the medication.
Diet has been shown to alter certain release characteristics of Lyrica but does not seem to effect its efficacy.