Drug of the Month: 4 Key Things to Know About Lyrica®

by Alan Rook, PharmaD, Clinical Pharmacist
Ashton Hamilton, PharmD candidate

Lyrica1. What is Lyrica?

Lyrica® (pregabalin) is FDA approved for fibromyalgia, diabetic peripheral neuropathic pain, neuropathic pain associated with spinal cord injury, partial-onset seizures (adjunctive therapy), and post-herpetic neuralgia. Lyrica is used off-label for general neuropathic pain, episodic migraine prevention, hot flashes, and restless leg syndrome. Current Official Disability Guidelines (ODG) suggest Lyrica and gabapentin as first-line treatments for neuropathic pain and have proven effectiveness, a favorable adverse effect profile, and a lack of major drug interactions.

2. How does Lyrica work and how is it available?

Neuropathic pain is a complex, chronic pain that is usually accompanied by tissue injury. Nerve fibers that are damaged or injured send incorrect signals to other pain centers. Common symptoms may include shooting or burning pain, in addition to tingling and numbness at the site of injury and areas around the injury.

Lyrica works by binding to voltage-gated calcium channels in the CNS tissue. This binding reduces the release of several neurotransmitters—which in turn inhibits the pain signal transmission. Common side effects for Lyrica include peripheral edema, dizziness, drowsiness, and weight gain.

Lyrica is available as an oral capsule that comes in 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, and 300 mg dosages. The usual dosage for neuropathic pain is 150-600 mg daily divided into 2-3 doses.

3.  Lyrica vs. Gabapentin

Lyrica and gabapentin have similar structures and mechanisms of action. Both Lyrica and gabapentin have analgesic, anticonvulsant, and anxiolytic activity. Although both drugs are considered first-line treatment options, gabapentin has a few advantages over Lyrica. Gabapentin is available in a generic form, while Lyrica is only available as the brand. The adverse effects and tolerability profile are similar for Lyrica and gabapentin.

The Average Wholesale Price (AWP) of Lyrica is $6.94 per 150 mg capsule. The medication is dosed twice daily requiring 60 tablets per month, making the AWP for a 30-day supply $416.40. Gabapentin is a more cost-effective option. A 30-day supply of gabapentin at the maximum recommended dose of 1800 mg per day (600 mg three times daily) has an AWP of approximately $259.20.

4.  Step therapy is recommended

myMatrixx recommends applying a step therapy approach starting with gabapentin by initiating a dose of 300 mg and gradually increasing the dose to the desired therapeutic effect or the maximum dose of 1800 mg per day in divided doses. If the patient is unable to continue with the medication because of side effects or lack of therapeutic effect, the prescriber should initiate a step therapy, discontinuing the use of gabapentin and switching to Lyrica.