What is Pre­ga­balin and why is it pre­scribed?

The Irish Times - Tuesday - Health - - Health Prescriptions - Dr Muiris Hous­ton

Pre­ga­balin (Lyrica) is one of a group of drugs called gabapenti­noids. The struc­ture of gabapenti­noids re­sem­bles the neu­ro­trans­mit­ter gam­maamino bu­tyric acid (Gaba), which has its own brain re­cep­tors.

Gaba is cen­tral to the anx­i­etyre­liev­ing ac­tion of drugs such as ben­zo­di­azepines. How­ever, gabapenti­noids do not act di­rectly on brain Gaba re­cep­tors and have dif­fer­ent bi­o­log­i­cal ef­fects.

The ex­act way that pre­ga­balin works is not fully un­der­stood, but it is thought to af­fect the way that cal­cium en­ters nerve cells. This re­duces the ac­tiv­ity of some of the nerve cells in the brain and spinal cord, re­duc­ing the re­lease of other neu­ro­trans­mit­ters that are in­volved in pain, epilepsy and anx­i­ety.

Orig­i­nally ap­proved for use in 2004, Lyrica has a prod­uct li­cence for three in­di­ca­tions in Ire­land: pain as­so­ci­ated with cer­tain types of nerve dam­age; epilepsy; and for the treat­ment of gen­er­alised anx­i­ety dis­or­der.

Ac­cord­ing to the drug’s of­fi­cial sum­mary of prod­uct char­ac­ter­is­tics (SPC), “af­ter dis­con­tin­u­a­tion of short-term and long-term treat­ment with pre­ga­balin, with­drawal symp­toms have been ob­served in some pa­tients.

The fol­low­ing events have been men­tioned: in­som­nia, headache, nau­sea, anx­i­ety, di­ar­rhoea, flu syn­drome, ner­vous­ness, de­pres­sion, pain, con­vul­sion, hy­per­hidro­sis (ex­ces­sive sweat­ing) and dizzi­ness, sug­ges­tive of phys­i­cal de­pen­dence . . . Con­vul­sions... may oc­cur dur­ing pre­ga­balin use or shortly af­ter dis­con­tin­u­ing pre­ga­balin.

“Con­cern­ing dis­con­tin­u­a­tion of long-term treat­ment of pre­ga­balin, data sug­gest that the in­ci­dence and sever­ity of with­drawal symp­toms may be dose-re­lated.”

The SPC also warns of po­ten­tial abuse or de­pen­dence with pre­ga­balin: “Cases of mis­use, abuse and de­pen­dence have been re­ported. Cau­tion should be ex­er­cised in pa­tients with a his­tory of sub­stance abuse and the pa­tient should be mon­i­tored for symp­toms of pre­ga­balin mis­use, abuse or de­pen­dence (de­vel­op­ment of tol­er­ance, dose es­ca­la­tion, drug-seek­ing be­hav­iour have been re­ported).”

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