Published online by Cambridge University Press: 06 October 2020
• Lyrica, Zeegap
• Antiepileptic drug (AED)
Commonly Prescribed for
(FDA approved in bold)
• Partial-onset seizures (adjunctive for adults)
• Neuropathic pain associated with post-herpetic neuralgia
• Neuropathic pain associated with diabetic peripheral neuropathy
• Neuropathic pain associated with spinal cord injury
• Facial pain
• Panic disorder
• Mania or bipolar disorder
• Generalized anxiety disorder
• Alcohol/benzodiazepine withdrawal
How the Drug Works
• Structural analog of GABA that binds at the α2δ subunit of calcium channel (CACNA2D1) and reduces calcium influx. Modulates calcium channel function but not a channel blocker
• Reduces release of excitatory neurotransmitters, such as glutamate, norepinephrine, and substance P
• Inactive at GABA receptors and does not affect GABA uptake or degradation
How Long Until It Works
• Seizures: 2 weeks
• Pain/anxiety: days to weeks
• Fibromyalgia: often in the first week
If It Works
• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated. Consider tapering and slowly stopping after 2 years without seizures, depending on the type of epilepsy
• Pain: goal is reduction of pain. Usually reduces but does not cure pain and there is recurrence off the medication. Consider tapering for conditions that may improve over time, e.g., post-herpetic neuralgia or fibromyalgia
If It Doesn't Work
• Epilepsy: consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind
• Pain: if not effective in 2 months, consider stopping or using another agent
Best Augmenting Combos for Partial Response or Treatment-Resistance
• Epilepsy: no major drug interactions with other AEDs. Using in combination may worsen CNS side effects or weight gain
• Neuropathic pain: TCAs, AEDs (gabapentin, pregabalin, carbamazepine, lamotrigine), SNRIs (duloxetine, venlafaxine, milnacipran, mirtazapine, bupropion), capsaicin, and mexiletine are agents used for neuropathic pain. Opioids (morphine, tramadol) may be appropriate for long-term use in some cases but require careful monitoring. Proven to decrease opioid requirements in patients with post-herpetic neuralgia
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