Pregabalin
Mechanism :
Precise mechanism of action unknown but is a GABA analogue that binds to a subunit of voltage-gated calcium channels in CNS; does not affect sodium channels, opiate receptors, or cyclo-oxygenase enzyme activity; interactions with descending noradrenergic and serotonergic pathways originating from the brain stem appear to reduce neuropathic pain transmission from spinal cord.
Indication :
- Neuropathic pain (diabetic, spinal cord injury associated)
- Post-herpetic neuralgia
- Adjunctive therapy in partial seizures
- Fibromyalgia
Contraindications :
Avoid abrupt withdrawal.
Dosing :
Partial Onset Seizures:
1 month to 16 years:
<29 kg: 3.5 mg/kg/day PO given in 2 or 3 divided doses; may increase the dosage weekly up to 14 mg/kg/day.
>30 kg: 2.5 mg/kg/day PO given in 2 or 3 divided doses; may increase the dosage weekly up to 10 mg/kg/day. Max: 600 mg/day.
Adverse Effect :
Hypersensitivity reaction, anaphylactoid reaction, angioedema, exfoliative dermatitis, Stevens-Johnson syndrome, thrombocytopenia, rhabdomyolysis, withdrawal seizures if abruptly discontinued.
Interaction :
Interaction Characteristics:
CNS depression.
Avoid/Use Alternative:
Doxylamine, Ginkgo.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 30-60 | Initial dose 75 mg daily and titrate according to tolerability and response |
| 15-30 | Initial dose 25–50 mg daily and titrate according to tolerability and response |
| <15 | Initial dose 25 mg daily and titrate according to tolerability and response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Dialysed. Dose as in GFR<15 mL/ min |
| HD | Dialysed. Dose as in GFR<15 mL/ min |
| HDF/High flux | Dialysed. Dose as in GFR<15 mL/ min |
| CAV/VVHD | Dialysed. Dose as in GFR=15– 30 mL/min |
Hepatic Dose :
No dose adjustment recommended.