Consumer medicine information

Lyrica

Pregabalin

BRAND INFORMATION

Brand name

Lyrica

Active ingredient

Pregabalin

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Lyrica.

What is in this leaflet

This leaflet answers some common questions about Lyrica.

It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking Lyrica against the benefits it is expected to have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What Lyrica is used for

Lyrica is used to treat neuropathic pain, which is pain caused by an abnormality of, or damage to, the nerves.

Lyrica is also used to control epilepsy. Epilepsy is a condition where you have repeated seizures (fits). There are many different types of seizures, ranging from mild to severe.

Lyrica belongs to a group of medicines called anticonvulsants. These medicines are thought to work by controlling brain chemicals which send signals to nerves so that seizures do not happen.

Lyrica also has pain relieving effects.

Lyrica may be used alone, or in combination with other medicines, to treat your condition.

Your doctor may prescribe Lyrica in addition to your current therapy when your current treatment is no longer working as well as before.

Ask your doctor if you have any questions about why Lyrica has been prescribed for you. Your doctor may have prescribed it for another reason.

This medicine is available only with a doctor's prescription.

Use in Children

There is not enough information to recommend the use of this medicine in children under the age of 18 years.

Before you take Lyrica

When you must not take it

Do not take Lyrica if you have an allergy to:

  • pregabalin, the active ingredient in Lyrica, or
  • any of the ingredients listed at the end of this leaflet.

Some of the symptoms of an allergic reaction may include:

  • shortness of breath, wheezing or difficulty breathing
  • swelling of the face, lips, tongue or other parts of the body
  • rash, itching or hives on the skin.

Do not take this medicine after the expiry date printed on the pack or if the packaging is torn or shows signs of tampering. If the capsules have expired or the pack is damaged, return to your pharmacist for disposal.

If you are not sure whether you should start taking this medicine, talk to your doctor.

Before you start to take it

Tell your doctor or pharmacist if you have allergies to:

  • any other medicines, especially barbiturates or any other anticonvulsant medicines
  • any other substances, such as foods, preservatives or dyes.

Tell your doctor if you have or have had any of the following medical conditions:

  • congestive heart failure
  • hereditary problems with galactose metabolism
  • kidney problems
  • diabetes
  • a history of substance abuse
  • depression.

Tell your doctor if you have a history of substance abuse. There have been reported cases of misuse and abuse with Lyrica.

Tell your doctor if you are pregnant or plan to become pregnant. Lyrica is not recommended for use during pregnancy. However, if you have epilepsy, it is very important to control your fits while you are pregnant. If it is necessary for you to take Lyrica, your doctor can help you decide whether or not to take it during pregnancy.

Tell your doctor if you are breast-feeding or plan to breast-feed. The active ingredient in Lyrica passes into breast milk and its safety in infants is unknown. It is recommended that you do not breast-feed while taking Lyrica.

If you have not told your doctor about any of the above, tell them before you start taking Lyrica.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including:

  • all prescription medicines
  • all medicines, vitamins, herbal supplements or natural therapies you buy without a prescription from a pharmacy, supermarket, naturopath or health food shop.

Some medicines may be affected by Lyrica or may affect how well it works. You may need different amounts of your medicines, or you may need to take different medicines. Your doctor will advise you.

Lyrica and certain other medicines may influence each other.

When taken with certain other medicines which reduce the activity of the brain, Lyrica may increase the side effects seen with these medicines, and could lead to respiratory failure, coma and death. The degree of dizziness, sleepiness and decreased concentration may be increased if Lyrica is taken together with medicines containing oxycodone (a pain-killer), lorazepam (used for treating anxiety), and alcohol.

Tell your doctor or pharmacist if you are taking any of the following:

  • medicines used to treat allergies (antihistamines)
  • medicines used to treat certain psychiatric disorders.

Taking these medicines together with Lyrica may increase your chance of experiencing side effects. You may need different amounts of your medicine, or you may need to take different medicines. Your doctor or pharmacist will advise you.

Your doctor and pharmacist have more information on medicines to be careful with or avoid while taking Lyrica.

How to take Lyrica

Follow all directions given to you by your doctor carefully. They may differ from the information contained in this leaflet.

If you do not understand the instructions on the box, ask your doctor or pharmacist for help.

How much to take

Your doctor will tell you how many capsules you need to take each day. This may depend on your age, your condition and whether or not you are taking any other medicines.

Your doctor may recommend that you start with a low dose of Lyrica and slowly increase the dose to the lowest amount needed to control your epilepsy/convulsions or neuropathic pain.

The usual dose range is 150 mg per day to 600 mg per day given in two divided doses.

How to take it

Swallow the capsules whole with a full glass of water.

When to take it

Take your medicine at about the same time each day. Taking it at the same time each day will have the best effect. It will also help you remember when to take it.

It does not matter if you take this medicine before or after food.

How long to take it

Continue taking your medicine for as long as your doctor tells you.

This medicine helps to control your condition, but does not cure it. It is important to keep taking your medicine, even if you feel well.

Do not stop taking Lyrica, or lower the dosage, without checking with your doctor. Do not let yourself run out of medicine over the weekend or on holidays. Stopping Lyrica suddenly may worsen your condition or cause unwanted effects such as sleeplessness, headache, nausea (feeling sick), anxiety, excessive sweating or diarrhoea (runny stools). If appropriate, your doctor will slowly reduce your dose before you can stop taking it completely.

If you forget to take it

If it is almost time for your next dose (within 4 hours), skip the dose you missed and take your next dose when you are meant to.

Otherwise, take it as soon as you remember, and then go back to taking your medicine as you would normally.

Do not take a double dose to make up for the dose that you missed. This may increase the chance of you getting an unwanted side effect.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering to take your medicine, ask your pharmacist for some hints.

If you take too much (overdose)

Immediately telephone your doctor or the Australian Poisons Information Centre (telephone 13 11 26) or the New Zealand National Poisons Information Centre (telephone 0800 POISON or 0800 764 766) for advice, or go to Accident and Emergency at the nearest hospital, if you think that you or anyone else may have taken too much Lyrica. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

Symptoms of an overdose with Lyrica may include mood changes, feeling tired, confusion, depression, agitation, restlessness or seizures.

While you are taking Lyrica

Things you must do

If you are about to be started on any new medicine, remind your doctor, dentist or pharmacist that you are taking Lyrica.

Tell any other doctors, dentists and pharmacists who treat you that you are taking this medicine.

If you are going to have surgery, tell the surgeon or anaesthetist that you are taking this medicine. It may affect other medicines used during surgery.

Tell your doctor immediately if you experience any changes in your vision. Lyrica may cause blurring or other changes in eyesight. Your doctor may ask you to stop taking Lyrica to improve these symptoms.

Tell your doctor immediately if you have any thoughts of suicide or self-harm, any unusual changes in mood or behaviour, or show signs of depression. Some people taking medicines to treat convulsions, such as Lyrica, have had thoughts of harming themselves or taking their life.

Patients and caregivers should be alert and monitor for these effects.

Signs and symptoms of suicidal risk include:

  • thoughts or talk of death or suicide
  • thoughts or talk of self-harm or harm to others
  • any recent attempts of self-harm
  • new or an increase in aggressive behaviour, irritability or agitation
  • new or worsening depression.

Mention of suicide or violence must be taken seriously.

If you or someone you know is demonstrating these warning signs of suicide while taking Lyrica, contact your doctor or a mental health professional right away.

Tell your doctor if you feel Lyrica is not helping your condition. Your doctor may need to change your medicine.

Tell your doctor if, for any reason, you have not taken Lyrica exactly as prescribed. Otherwise, your doctor may change your treatment unnecessarily.

If you become pregnant while taking Lyrica, tell your doctor immediately.

Keep all of your doctor's appointments so that your progress can be checked. Your doctor may do some tests from time to time to make sure the medicine is working and to prevent unwanted side effects.

Things you must not do

Do not take Lyrica to treat any other complaints unless your doctor tells you to.

Do not give your medicine to anyone else, even if their symptoms seem similar to yours or they have the same condition as you.

Do not stop taking your medicine or lower the dosage without checking with your doctor.

Things to be careful of

Be careful driving or operating machinery until you know how Lyrica affects you. As with other anticonvulsant medicines, Lyrica may cause dizziness and drowsiness in some people. If you have any of these symptoms, do not drive, operate machinery or do anything else that could be dangerous.

Be careful when drinking alcohol while you are taking this medicine. If you drink alcohol, symptoms such as dizziness and drowsiness may be worse.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Lyrica.

Lyrica helps most people with neuropathic pain or epilepsy, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.

It can be difficult to tell whether side effects are the result of taking Lyrica, effects of your condition or side effects of other medicines you may be taking. For this reason it is important to tell your doctor of any change in your condition.

If you are over 65 years of age you may have an increased chance of getting side effects.

Do not be alarmed by the list of side effects. You may not experience any of them.

If you get any side effects, do not stop taking Lyrica without first talking to your doctor or pharmacist.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if...

Tell your doctor or pharmacist if you notice any of the following and they worry you:

  • dizziness
  • feeling tired or drowsy
  • constipation
  • diarrhoea
  • nausea
  • headache
  • increase in weight
  • unsteadiness when walking, reduced co-ordination, shaking or tremors
  • dry mouth
  • blurred or double vision.

The above list includes the more common side effects of your medicine. They are usually mild and short-lived.

Tell your doctor as soon as possible if...

Tell your doctor as soon as possible if you notice any of the following:

  • unusual changes in mood or behaviour
  • signs of new or increased irritability or agitation
  • signs of depression
  • swelling of the hands, ankles or feet
  • enlargement of breasts
  • unexplained muscle pain, tenderness and weakness
  • passing little to no urine.

The above list includes serious side effects that may require medical attention. Serious side effects are rare.

Go to hospital if...

Tell your doctor immediately or go to Accident and Emergency at your nearest hospital, if you notice any of the following:

  • shortness of breath, swelling of the feet and legs, weight increase due to fluid build-up
  • irritated red eyes that are sensitive to light
  • more frequent or more severe seizures (fits)
  • sudden signs of allergy such as rash, itching or hives, swelling of the face, lips, tongue or other parts of the body, shortness of breath, wheezing or difficulty breathing.

The above list includes very serious side effects. You may need urgent medical attention or hospitalisation. These side effects are very rare.

Tell your doctor or pharmacist if you notice anything else that is making you feel unwell. Other side effects not listed above may also occur in some people. Some of these side effects (for example, changes in blood pressure) can only be found when your doctor does tests from time to time to check your progress.

After taking Lyrica

Storage

Keep your capsules in the pack until it is time to take them. If you take the capsules out of the pack they may not keep well.

Keep your capsules in a cool dry place where the temperature stays below 25°C.

Do not store Lyrica or any other medicine in the bathroom or near a sink. Do not leave it on a windowsill or in the car on hot days. Heat and dampness can destroy some medicines.

Keep it where children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking this medicine or the expiry date has passed, ask your pharmacist what to do with any medicine that is left over.

Product Description

What it looks like

25 mg - White hard gelatin capsule, marked "Pfizer PGN 25" with black ink.

75mg - White and orange hard gelatin capsule, marked "Pfizer PGN 75" with black ink.

150mg - White hard gelatin capsule, marked "Pfizer PGN 150" with black ink.

300mg - White and orange hard gelatin capsule, marked "Pfizer PGN 300" with black ink.

Each pack contains 56 capsules.

Ingredients

Active Ingredients

25 mg capsules - 25 mg pregabalin

75 mg capsules - 75 mg pregabalin

150 mg capsules - 150 mg pregabalin

300 mg capsules - 300 mg pregabalin

It also contains:

  • Lactose monohydrate
  • Maize starch
  • Purified talc
  • Gelatin
  • Purified water
  • Titanium dioxide
  • Sodium lauryl sulfate
  • Colloidal anhydrous silica
  • TekPrint SW-9009 black ink
  • TekPrint SW-9008 black ink
  • Iron oxide red (75 mg and 300 mg capsules only).

Supplier

Lyrica is supplied in Australia by:

Pfizer Australia Pty Ltd
ABN 50 008 422 348
Sydney NSW 2000
Toll Free number: 1800 675 229

Australian Registration Numbers

25 mg capsules: AUST R 99469

75 mg capsules: AUST R 99520

150 mg capsules: AUST R 99528

300 mg capsules: AUST R 99537

Date of preparation

This leaflet was prepared in October 2019.

® Registered trademark

© Pfizer Australia Pty Ltd 2016.

pfcyric11019.

Published by MIMS December 2019

BRAND INFORMATION

Brand name

Lyrica

Active ingredient

Pregabalin

Schedule

S4

 

1 Name of Medicine

Pregabalin.

6.7 Physicochemical Properties

Pregabalin is a white to off-white solid.  It is freely soluble in water and basic and acidic aqueous solutions.

Chemical structure.


Chemical name: (S)-3-(aminomethyl)-5-methylhexanoic acid.
Molecular formula: C8H17NO2.
Molecular weight: 159.23.

CAS number.

148553-50-8.

2 Qualitative and Quantitative Composition

Lyrica capsules contain 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg or 300 mg pregabalin.

Excipient(s) with known effect.

Sugars as lactose monohydrate.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Lyrica 25 mg capsules: white hard gelatin capsule, marked 'Pfizer' on the cap and 'PGN 25' on the body with black ink.
Lyrica 50 mg capsules: white hard gelatin capsule, marked 'Pfizer' on the cap and 'PGN 50' on the body with black ink. The body is also marked with a black band.
Lyrica 75 mg capsules: white and orange hard gelatin capsule, marked 'Pfizer' on the cap and 'PGN 75' on the body with black ink.
Lyrica 100 mg capsules: orange hard gelatin capsule, marked 'Pfizer' on the cap and 'PGN 100' on the body with black ink.
Lyrica 150 mg capsules: white hard gelatin capsule, marked 'Pfizer' on the cap and 'PGN 150' on the body with black ink.
Lyrica 200 mg capsules: light orange hard gelatin capsule, marked 'Pfizer' on the cap and 'PGN 200' on the body with black ink.
Lyrica 225 mg capsules: white and light orange hard gelatin capsule, marked 'Pfizer' on the cap and 'PGN 225' on the body with black ink.
Lyrica 300 mg capsules: white and orange hard gelatin capsule, marked 'Pfizer' on the cap and 'PGN 300' on the body with black ink.

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Pregabalin is an analogue of the neurotransmitter gamma-aminobutyric acid (GABA). It has analgesic and anticonvulsant activity.
In vitro studies show that pregabalin binds to an auxiliary subunit (α2-δ protein) of voltage-gated calcium channels in the central nervous system, potently displacing [3H]-gabapentin. Two lines of evidence indicate that binding of pregabalin to the α2-δ site is required for analgesic and anticonvulsant activity in animal models: (1) studies with the inactive R-enantiomer and other structural derivatives of pregabalin and (2) studies of pregabalin in mutant mice with defective drug binding to the α2-δ protein. In addition, pregabalin reduces the release of several neurotransmitters, including glutamate, noradrenaline, and substance P. The significance of these effects for the clinical pharmacology of pregabalin is not known.
Pregabalin does not show affinity for receptor sites or alter responses associated with the action of several common drugs for treating seizures or pain. Pregabalin does not interact with either GABAA or GABAB receptors; it is not converted metabolically into GABA or a GABA agonist; it is not an inhibitor of acute GABA uptake or degradation.
Pregabalin prevents pain-related behaviours in animal models of neuropathic and post-surgical pain, including hyperalgesia and allodynia.
Pregabalin also shows efficacy in animal models of seizures, including maximal electroshock tonic extensor seizures in mice or rats, threshold clonic seizures from pentylenetetrazol, behavioural and electrographic seizures in hippocampal kindled rats, and tonic and clonic seizures in DBA/2 audiogenic mice. Pregabalin does not reduce the incidence of spontaneous absence seizures in Genetic Absence Epilepsy in Rats from Strasbourg (GAERS).

Clinical trials.

Neuropathic pain.

The effectiveness of pregabalin for the management of neuropathic pain was investigated in 11 double blind, placebo-controlled, multi-centre studies with either twice a day (BID) or three times a day (TID) dosing.
The analysis of the primary efficacy variable is provided below for each study within the diabetic peripheral neuropathy, and post-herpetic neuralgia population.
The overall picture of the primary efficacy variable across populations is confirmed by the responder rates. The response rates for a 30% reduction in pain score showed that the proportion of patients responding increased with increasing doses from 34-49% at 150 mg per day to 54-65% at 600 mg per day, compared with 19-45% for placebo. The response rates for a 50% reduction in pain score showed that the proportion of patients responding increased with increasing doses, from 19-34% at 150 mg per day to 39-50% at 600 mg per day, compared with 8-30% for placebo.
Up to 88% of patients treated with 300 or 600 mg/day pregabalin reported benefit, compared with 26-66% for placebo, as measured by an improvement in the Patient Global Impressions of Change (PGIC) score. The PGIC is a patient-rated instrument that measures change in a patient's overall status on a scale ranging from 1 (very much improved) to 7 (very much worse).
A significant reduction in pain was seen by Week 1 and maintained relative to placebo throughout the treatment. Significant reductions in sleep interference were seen, when patients were treated with pregabalin for neuropathic pain, by Week 1 and maintained throughout the treatment.

Diabetic peripheral neuropathy (DPN).

The effectiveness of pregabalin for the management of neuropathic pain was investigated in 6 double blind, placebo-controlled, multi-centre studies with either twice a day (BID) or three times a day (TID) dosing. A total of 1525 patients were enrolled in the 6 studies. To enter the study patients had to have moderate to severe pain. The mean age of patients in these studies was 59 years (range 21-85 years), 89% of patients had Type II diabetes mellitus with an average HbA1c of 8.9%.
In the 5 completed studies, the average age was 59 years, the duration of diabetes was 11 years, and the average baseline pain score was 6.5. The use of concurrent medication that may affect the assessments was prohibited. Antidiabetic medication was required to be stable and constant during the study. (See Table 5.)

Post-herpetic neuralgia (PHN).

The effectiveness of pregabalin for the management of neuropathic pain was investigated in 5 double blind, placebo-controlled, multi-centre studies with either twice a day (BID) or three times a day (TID) dosing. A total of 1250 patients were enrolled in the 5 studies. To enter the study patients had to have moderate to severe pain for ≥ 3 months (or ≥ 6 months in one study). The mean duration of PHN for patients in these studies was 3 years (range < 1-22 years).
In the 4 completed studies, the average age was 71 years, the average duration of PHN was 38 months, and the average baseline pain score was 6.6. Concomitant use of analgesics and antidepressants was allowed, provided the regimen was stable and in place at the time of randomisation. (See Table 6.)

Epilepsy.

The efficacy of pregabalin as adjunctive therapy was investigated in three 12-week, randomised, double blind, placebo controlled, multi-centre studies involving 1052 patients, with BID and/or TID dosing. Patients had refractory partial seizures with or without secondary generalisation and had mean baseline seizure rates of 21-22 and median baseline seizure rates of 10-12 seizures per 28 days.
The primary efficacy measure in all studies was based on seizure reduction as analysed by response ratio (RRatio), a measure of change defined as [(T - B)/(T + B)] x 100, where B is the patient's baseline seizure frequency and T is the patient's seizure frequency during treatment. The RRatio is distributed within the range -100 to +100. A zero value indicates no change and a complete elimination of seizures would give a value of -100. Responder rate was defined as the proportion of patients who have a ≥ 50% reduction in partial seizure frequency during treatment as compared to baseline (see Table 7).
A significant reduction in seizure frequency was observed by Week 1. Overall, there was a significant reduction in seizure frequency over the 12-week treatment period.
Long-term efficacy data in support of the chronic use of pregabalin for the treatment of patients with partial seizures were provided by four open label extension studies. These studies permitted pregabalin as adjunctive therapy with marketed AEDs. Data from the long-term studies support the long-term use of pregabalin for the treatment of patients with partial seizures, as well as demonstrating the maintenance of effect over the long-term.

5.2 Pharmacokinetic Properties

Pregabalin steady-state pharmacokinetics are similar in healthy volunteers, patients with epilepsy receiving anti-epileptic drugs and patients with chronic pain.

Absorption.

Pregabalin is rapidly absorbed when administered in the fasted state, with peak plasma concentrations occurring within 1 hour following both single and multiple dose administration. Pregabalin oral bioavailability is estimated to be ≥ 90% and is independent of dose. Following repeated administration, steady state is achieved within 24 to 48 hours. The rate of pregabalin absorption is decreased when given with food resulting in a decrease in Cmax by approximately 25-30% and a delay in Tmax to approximately 2.5 hours. However, administration of pregabalin with food has no clinically significant effect on the extent of pregabalin bioavailability.

Distribution.

In preclinical studies, pregabalin has been shown to cross the blood brain barrier in mice, rats and monkeys. Pregabalin has been shown to cross the placenta in rats and is present in the milk of lactating rats. In humans, the apparent volume of distribution of pregabalin following oral administration is approximately 0.56 L/kg. Pregabalin is not bound to plasma proteins. At clinical doses of 150 to 600 mg/day, the average steady-state plasma pregabalin concentrations were approximately 1.5 and 6.0 microgram/mL, respectively.

Metabolism.

Pregabalin undergoes negligible metabolism in humans. Following a dose of radiolabelled pregabalin, approximately 98% of the radioactivity recovered in the urine was unchanged pregabalin. The N-methylated derivative of pregabalin, the major metabolite of pregabalin found in urine, accounted for 0.9% of the dose. In preclinical studies, there was no indication of racemisation of pregabalin S-enantiomer to the R-enantiomer.

Excretion.

Pregabalin is eliminated from the systemic circulation primarily by renal excretion as unchanged drug. Renal clearance (CLcr) derived from Phase I studies was 73 mL/min.
Pregabalin mean elimination half-life is 6.3 hours. Pregabalin plasma clearance and renal clearance are directly proportional to creatinine clearance (see Special populations, Renal impairment).
Pregabalin clearance is reduced in patients with impaired renal function (see Section 4.2 Dose and Method of Administration, Renal impairment, Table 1).

Linearity/ non-linearity.

Pregabalin pharmacokinetics are linear over the recommended daily dose range. Inter-subject pharmacokinetic variability for pregabalin is low (< 20%). Multiple dose pharmacokinetics are predictable from single dose data.

Special populations.

Race.

Population pharmacokinetic analyses of the Phase 2/3 studies in patients with chronic pain, general anxiety disorder (GAD) or partial seizures showed that the relationship between daily dose and pregabalin exposure is similar among Caucasians, Blacks and Hispanics.

Gender.

Population pharmacokinetic analyses of the Phase 2/3 studies in patients with chronic pain, GAD or partial seizures showed that the relationship between daily dose and pregabalin drug exposure is similar between genders when adjusted for gender-related differences in CLcr.

Renal impairment.

Pregabalin clearance is directly proportional to creatinine clearance. In addition, pregabalin is effectively removed from plasma by haemodialysis (following a four hour haemodialysis treatment plasma pregabalin concentrations are reduced by approximately 50%). Because renal elimination is the major elimination pathway, dosage reduction in patients with renal impairment and dosage supplementation following haemodialysis is necessary (see Section 4.2 Dose and Method of Administration, Renal impairment, Table 1).

Hepatic impairment.

No specific pharmacokinetic studies were carried out in patients with impaired liver function. Since pregabalin does not undergo significant metabolism and is excreted predominantly as unchanged drug in the urine, impaired liver function would not be expected to significantly alter pregabalin plasma concentrations.

Elderly (> 65 years).

Pregabalin clearance tends to decrease with increasing age. This decrease in pregabalin oral clearance is consistent with decreases in creatinine clearance associated with increasing age. Reduction of pregabalin dose may be required in patients who have age related compromised renal function (see Section 4.2 Dose and Method of Administration, Renal impairment, Table 1).

Children and adolescents (< 18 years).

No specific pharmacokinetic studies have been undertaken in patients < 18 years of age.

Breastfeeding women.

The pharmacokinetics of 150 mg pregabalin given every 12 hours (300 mg daily dose) was evaluated in 10 lactating women who were at least 12 weeks postpartum. Lactation had little to no influence on pregabalin pharmacokinetics. Pregabalin was excreted into breast milk with average steady-state concentrations approximately 76% of those in maternal plasma. The estimated average daily infant dose of pregabalin from breast milk (assuming mean milk consumption of 150 mL/kg/day) was 0.31 mg/kg/day, which on a mg/kg basis would be approximately 7% of the maternal dose (see Section 4.6 Fertility, Pregnancy and Lactation, Use in lactation).

5.3 Preclinical Safety Data

Genotoxicity.

Pregabalin is not genotoxic based on results of in vitro and in vivo tests. It was not mutagenic in bacteria or in mammalian cells in vitro, not clastogenic in mammalian systems in vitro and in vivo, and did not induce unscheduled DNA synthesis in mouse or rat hepatocytes.

Carcinogenicity.

Two-year carcinogenicity studies with pregabalin were conducted in rats and mice. No increased incidence of tumours was observed in rats at exposures (plasma AUC) up to 25 times the expected human exposure at the maximum recommended clinical dose of 600 mg/day. In mice, no increased incidence of tumours was found at exposures similar to the expected maximum human exposure, but an increased incidence of haemangiosarcoma was observed at exposures 6 to 33 times the expected maximum human exposure. The precise non-genotoxic mechanism of pregabalin induced tumour formation is not fully characterised. However, available data show that platelet changes associated with the formation of this tumour in mice are not seen in rats, monkeys or humans. Although long-term data in humans are limited, these findings in mice are thought not to pose a risk to humans.

4 Clinical Particulars

4.1 Therapeutic Indications

Lyrica (pregabalin) is indicated for the treatment of neuropathic pain in adults.
Lyrica (pregabalin) is indicated as adjunctive therapy in adults with partial seizures with or without secondary generalisation.

4.3 Contraindications

Lyrica is contraindicated in patients who have demonstrated hypersensitivity to pregabalin or to any of the excipients.

4.4 Special Warnings and Precautions for Use

Hereditary problems of galactose metabolism.

Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

Weight gain.

In the controlled studies, weight gain occurred more frequently in patients treated with Lyrica than in patients treated with placebo. Lyrica associated weight gain was related to dose and length of exposure, but did not appear to be associated with baseline BMI, gender or age.
In accordance with current clinical practice, some diabetic patients who gain weight on Lyrica treatment may need to adjust hypoglycaemic medications.

Hypersensitivity reactions.

There have been reports in the post-marketing experience of hypersensitivity reactions, including cases of angioedema. Lyrica should be discontinued immediately if symptoms of angioedema, such as facial, perioral, or upper airway swelling occur.

Dizziness and somnolence.

Lyrica causes dizziness and somnolence (see Section 4.8 Adverse Effects (Undesirable Effects)). In the controlled studies, dizziness and somnolence generally began shortly after initiation of Lyrica and occurred more frequently at higher doses. Dizziness and somnolence were the adverse events most frequently leading to withdrawal (4% each) from controlled studies. In pregabalin-treated patients reporting these adverse events in short-term controlled studies, dizziness persisted until the last dose in 31% and somnolence persisted until the last dose in 46%.
There have also been reports of loss of consciousness, confusion, and mental impairment.

Suicidal behaviour and ideation.

Antiepileptic drugs (AED), including Lyrica, increase the risk of suicidal thoughts or behaviour in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behaviour, and/or any unusual changes in mood or behaviour.
Pooled analyses of 199 placebo-controlled clinical trials (mono- and adjunctive therapy) of 11 different AEDs showed that patients randomised to one of the AEDs had approximately twice the risk (adjusted Relative Risk 1.8, 95% CI:1.2, 2.7) of suicidal thinking or behaviour compared to patients randomized to placebo. In these trials, which had a median treatment duration of 12 weeks, the estimated incidence rate of suicidal behaviour or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% among 16,029 placebo-treated patients, representing an increase of approximately one case of suicidal thinking or behaviour for every 530 patients treated. There were four suicides in drug-treated patients in the trials and none in placebo-treated patients, but the number is too small to allow any conclusion about drug effect on suicide.
The increased risk of suicidal thoughts or behaviour with AEDs was observed as early as one week after starting drug treatment with AEDs and persisted for the duration of treatment assessed. Because most trials included in the analysis did not extend beyond 24 weeks, the risk of suicidal thoughts or behaviour beyond 24 weeks could not be assessed.
The risk of suicidal thoughts or behaviour was generally consistent among drugs in the data analysed. The finding of increased risk with AEDs of varying mechanisms of action and across a range of indications suggests that the risk applies to all AEDs used for any indication. The risk did not vary substantially by age (5-100 years) in the clinical trials analysed. Table 2 shows absolute and relative risk by indication for all evaluated AEDs.
The relative risk for suicidal thoughts or behaviour was higher in clinical trials for epilepsy than in clinical trials for psychiatric or other conditions, but the absolute risk differences were similar for the epilepsy and psychiatric indications.
Anyone considering prescribing pregabalin or any other AED must balance this risk with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behaviour. Should suicidal thoughts and behaviour emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated.
Patients, their caregivers, and families should be informed that AEDs increase the risk of suicidal thoughts and behaviour and should be advised of the need to be alert for the emergence or worsening of the signs and symptoms of depression, any unusual changes in mood or behaviour, or the emergence of suicidal thoughts, behaviour, or thoughts about self-harm. Behaviours of concern should be reported immediately to the treating doctor.

Monotherapy for seizure control.

There are insufficient data on seizure control when Lyrica is used as monotherapy once concomitant antiepileptic medical products have been withdrawn in patients where Lyrica was used as add-on therapy.

Substance misuse, abuse and dependence.

There have been post-marketing reports of substance misuse and abuse with Lyrica. As with any CNS drug, patients should be carefully evaluated for a history of substance abuse and observed for signs of Lyrica misuse or abuse (e.g. development of tolerance, increase in dose, drug-seeking behaviour).

Renal failure.

Renal failure is a rare adverse reaction to Lyrica. Although the effects of discontinuation on the reversibility of renal failure have not been systematically studied, cases of renal failure have been reported and in some cases discontinuation of Lyrica did show reversibility of this adverse reaction.

Discontinuation.

After discontinuation of short-term and long-term treatment with Lyrica, withdrawal symptoms have been observed in some patients. The following events have been mentioned: insomnia, headache, nausea, anxiety, hyperhidrosis and diarrhoea.

Congestive heart failure.

There have been post-marketing reports of congestive heart failure in some patients receiving Lyrica. Lyrica should be used with caution in these patients.

Blurred vision.

In controlled studies, a higher proportion of patients treated with Lyrica reported blurred vision than did patients treated with placebo (see Section 4.8 Adverse Effects (Undesirable Effects)). In the majority of cases, blurred vision resolved with continued dosing. If blurred vision persists, further assessment should be considered.
Post-marketing experience with Lyrica has reported transient visual blurring and other changes in visual acuity. Discontinuation of Lyrica may result in resolution or improvement of these visual symptoms.

Peripheral oedema.

In controlled studies, peripheral oedema occurred more frequently in patients treated with Lyrica than in patients treated with placebo (see Section 4.8 Adverse Effects (Undesirable Effects)). Peripheral oedema was not associated with laboratory changes suggestive of deterioration in renal or hepatic function. There are limited data on the use of Lyrica in patients with congestive heart failure, and Lyrica should be used with caution in these patients.

Creatine kinase elevations.

Treatment with Lyrica was associated with creatine kinase elevations. Mean changes in creatine kinase from baseline to the maximum value were 60 U/L for pregabalin treated patients and 28 U/L for the placebo patients. In all controlled trials across multiple patient populations, 2% of patients on pregabalin and 1% of placebo patients had a value of creatine kinase at least three times the upper limit of normal. Three Lyrica treated subjects had events reported as rhabdomyolysis in premarketing clinical trials. The relationship between these myopathy events and Lyrica is not completely understood because the cases had documented factors that may have caused or contributed to these events. Lyrica should be discontinued if myopathy is diagnosed or suspected or if markedly elevated creatine kinase levels occur.

Opioids.

Caution is advised when prescribing pregabalin concomitantly with opioids due to risk of CNS depression. In an observational study of opioid users, those patients who took pregabalin concomitantly with an opioid had an increased risk for opioid-related death compared to opioid use alone (adjusted odds ratio [aOR], 1.68 [95% CI, 1.19 to 2.36]).

Use in the elderly (> 65 years).

Lyrica treatment has been associated with dizziness and somnolence, which may increase the occurrence of accidental injury (falls) in the elderly population.

Paediatric use.

The safety and effectiveness of pregabalin has not been established in patients below the age of 18 years, with either epilepsy or neuropathic pain.

Effects on laboratory tests.

Lyrica is not known to interfere with any laboratory tests. Some changes in clinical laboratory tests have been noted in patients taking Lyrica (see Section 4.8 Adverse Effects (Undesirable Effects), Table 4, Investigations).

4.5 Interactions with Other Medicines and Other Forms of Interactions

Since pregabalin is predominantly excreted unchanged in the urine, undergoes negligible metabolism in humans (< 2% of a dose recovered in urine as metabolites), does not inhibit drug metabolism in vitro, and is not bound to plasma proteins, pregabalin is unlikely to produce, or be subject to, pharmacokinetic interactions.
Accordingly, in in vivo studies no clinically relevant pharmacokinetic interactions were observed between pregabalin and phenytoin, carbamazepine, valproic acid, lamotrigine, gabapentin, lorazepam, oxycodone or ethanol. In addition, population pharmacokinetic analysis indicated that the three commonly used drug classes, oral antidiabetics, diuretics and insulin, and the commonly used antiepileptic drugs phenytoin, carbamazepine, valproic acid, lamotrigine, phenobarbital, tiagabine and topiramate, had no clinically significant effect on pregabalin clearance. Similarly, these analyses indicated that pregabalin had no clinically significant effect on the clearance of phenytoin, carbamazepine, valproic acid, lamotrigine, topiramate and phenobarbital.
Co-administration of pregabalin with the oral contraceptives norethisterone and/or ethinylestradiol does not influence the steady-state pharmacokinetics of either agent.
Pregabalin may potentiate the effects of ethanol and lorazepam. In controlled clinical trials, multiple oral doses of pregabalin co-administered with oxycodone, lorazepam, or ethanol did not result in clinically important effects on respiration. Pregabalin appears to be additive in the impairment of cognitive and gross motor function caused by oxycodone.
In post-marketing experience, there are reports of respiratory failure, coma and deaths in patients taking pregabalin and other CNS depressant medications, including in patients who are substance abusers. There are post-marketing reports of events related to reduced lower gastrointestinal tract function (e.g. intestinal obstruction, paralytic ileus, constipation) when pregabalin was co-administered with medications that have the potential to produce constipation, such as opioid analgesics.
No specific pharmacodynamic interaction studies were conducted in elderly volunteers.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

Preclinical data.

In male rats, oral administration of high doses of pregabalin resulted in reversible decreased sperm motility and fertility. These were not observed at exposures (plasma AUC) up to 11 times the expected human exposure at the maximum recommended clinical dose of 600 mg/day. There were also no drug-related effects on sperm parameters in a long-term monkey study with exposures up to 8 times the expected maximum human exposure. In female rats, oestrus cycles were prolonged by high oral doses of pregabalin, but fertility was unaffected, and an increase in post-implantation loss also occurred. No adverse effects were seen at an exposure approximately 50 times the expected maximum human exposure.

Human data.

In a double-blind, placebo-controlled clinical trial to assess the effect of pregabalin on sperm motility, 30 of 46 healthy male subjects were exposed to pregabalin at 600 mg/day for 3 months. Pregabalin did not exhibit detrimental effects on the reproductive function of healthy male subjects, as measured by semen analysis.
(Category B3)
Lyrica has not been studied in pregnant women and Lyrica should not be used during pregnancy unless the benefit to the mother clearly outweighs the potential risk to the fetus. In a pre- and post-natal study in rats, pregabalin treatment resulted in offspring developmental toxicity at exposures (plasma AUC) ≥ 5 times the expected human exposure at the maximum recommended clinical dose of 600 mg/day. Offspring development was unaffected at 2 times the expected maximum human exposure.

Labour and delivery.

The effects of Lyrica on labour and delivery in pregnant women are unknown. In a pre- and post-natal development study in rats, pregabalin prolonged gestation and induced dystocia at exposures (plasma AUC) approximately 50 times the expected human exposure at the maximum recommended clinical dose of 600 mg/day. These effects were not observed at an exposure that was approximately 12 times the expected human exposure.

Teratogenicity.

Pregabalin was not teratogenic in mice, rats or rabbits. Fetal developmental toxicity was not observed after treatment of pregnant mice and rabbits with oral doses that resulted in respective pregabalin exposures that were 30 times and 17 times the expected human exposure at the maximum recommended clinical dose of 600 mg/day. Increased fetal skeletal variations were seen in rats at oral doses resulting in exposures > 17 times the expected maximum human exposure, but lower doses were not tested in a full study.
Pregabalin is excreted in the milk of lactating women (see Section 5.2 Pharmacokinetic Properties, Breastfeeding women). As the safety of pregabalin in infants is not known, breastfeeding is not recommended in women taking Lyrica. A decision must be made whether to discontinue breastfeeding or to discontinue Lyrica therapy, taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman.

4.8 Adverse Effects (Undesirable Effects)

The pregabalin clinical programme involved over 9000 patients who were exposed to pregabalin, of whom over 5000 were in double-blind placebo-controlled trials. The clinical efficacy program included patients treated for a maximum of 12 weeks duration.
The most commonly reported adverse reactions were dizziness and somnolence. Adverse reactions were usually mild to moderate in intensity. In all controlled studies, the discontinuation rate due to adverse reactions was 13% for patients receiving pregabalin and 7% for patients receiving placebo. The most common adverse reactions resulting in discontinuation from pregabalin treatment groups were dizziness and somnolence.
The adverse effects listed may also be associated with the underlying disease and concomitant medications. (See Table 3.)
Additional adverse reactions reported in a pooled analysis of all pregabalin clinical trials are listed in Table 4 by System Organ Class (SOC). The frequency of these terms have been based on all-causality adverse drug reactions in the clinical trial data set (very common (≥ 1/10), common (≥ 1/100, < 1/10), uncommon (≥ 1/1000, < 1/100) and rare (< 1/1000)).

Post-marketing experience.

The following adverse drug reactions were reported during post-marketing surveillance:

Immune system disorders.

Uncommon: hypersensitivity. Rare: angioedema, allergic reaction.

Nervous system disorders.

Very common: headache. Uncommon: loss of consciousness, mental impairment.

Cardiac disorders.

Rare: congestive heart failure.

Eye disorders.

Rare: keratitis.

Gastrointestinal disorders.

Common: nausea, diarrhoea. Rare: swollen tongue.

General disorders and administration site conditions.

Uncommon: malaise.

Skin and subcutaneous tissue disorders.

Uncommon: face swelling, pruritus, alopecia.

Renal and urinary disorders.

Rare: urinary retention.

Reproductive system and breast disorders.

Rare: gynaecomastia.

Respiratory, thoracic and mediastinal disorders.

Rare: pulmonary oedema.

Vital signs.

No consistent changes in vital signs have been seen in patients taking Lyrica. Changes in vital signs reported in controlled clinical trials are shown in Table 4.

Elderly (> 65 years).

In a total of 998 elderly patients, no overall differences in safety were observed compared with patients less than 65 years of age.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.2 Dose and Method of Administration

Dosage.

The dose range is 150 to 600 mg per day given in two divided doses.
Lyrica may be taken with or without food.

Neuropathic pain.

Lyrica treatment can be started at a dose of 150 mg per day, given as two divided doses. Based on individual patient response and tolerability, the dosage may be increased to 300 mg per day, given as two divided doses, after an interval of 3 to 7 days, and if needed, to a maximum dose of 600 mg per day after an additional 7-day interval.
Since diabetes is frequently complicated by renal disease, patients with diabetic neuropathy, in accordance with current clinical practice, should be assessed for renal impairment prior to commencing Lyrica and dosage adjusted appropriately.
The effectiveness of Lyrica in the treatment of neuropathic pain has not been assessed in controlled clinical trials for treatment periods longer than 12 weeks (see Section 5.1 Pharmacodynamic Properties, Clinical trials). The risks and benefits of treatment to an individual patient should be assessed before extending therapy for longer than 12 weeks.

Epilepsy.

Lyrica treatment can be started with a dose of 150 mg per day given as two divided doses. Based on individual patient response and tolerability, the dosage may be increased to 300 mg per day given as two divided doses after 1 week. The maximum dosage of 600 mg per day given as two divided doses may be achieved after an additional week.
It is not necessary to monitor plasma pregabalin concentrations to optimise Lyrica therapy. Pregabalin does not alter the plasma concentrations of other commonly used anti-convulsant drugs. Similarly, commonly used anti-convulsant drugs do not alter plasma concentrations of pregabalin (see Section 4.5 Interactions with Other Medicines and Other Forms of Interactions).

Discontinuation of Lyrica.

In accordance with current clinical practice, if Lyrica has to be discontinued, it is recommended to withdraw it gradually over a minimum of one week.

Dosage adjustment.

Renal impairment.

Pregabalin is eliminated from the systemic circulation primarily by renal excretion as unchanged drug. As pregabalin clearance is directly proportional to creatinine clearance (see Section 5.2 Pharmacokinetic Properties, Excretion), dosage reduction in patients with compromised renal function must be individualised according to creatinine clearance (CLcr), as indicated in Table 1 determined using the following formula:
Pregabalin is removed effectively from plasma by haemodialysis (50% of drug in 4 hours). For patients receiving haemodialysis, the pregabalin daily dose should be adjusted based on renal function. In addition to the daily dose, a supplementary dose should be given immediately following every 4-hour haemodialysis treatment (see Table 1).

Hepatic impairment.

No dosage adjustment is required for patients with hepatic impairment (see Section 5.2 Pharmacokinetic Properties, Hepatic impairment).

Children and adolescents (< 18 years).

The safety and effectiveness of pregabalin has not been established in patients below the age of 18 years, with either epilepsy or neuropathic pain.

Elderly (> 65 years).

No dosage adjustment is necessary for elderly patients unless their renal function is compromised (see Table 1).

4.7 Effects on Ability to Drive and Use Machines

Lyrica may cause dizziness and somnolence and, therefore, may have an influence on the ability to drive or use machines. Patients are advised not to drive, operate complex machinery or engage in other potentially hazardous activities until it is known whether this medication affects their ability to perform these activities.

4.9 Overdose

Signs and symptoms.

In overdoses up to 15 g, no unexpected adverse effects were reported.
In post-marketing experience, the most commonly reported adverse events observed when Lyrica was taken in overdose included affective disorder, somnolence, confusional state, depression, agitation and restlessness. Seizures were also reported.

Recommended treatment.

There is no specific antidote for Lyrica. Treatment of Lyrica overdose should be symptomatic and supportive.
Consider administration of activated charcoal in the event of a potentially toxic ingestion. Activated charcoal is most effective when administered within one hour of ingestion. In patients who are not fully conscious or have impaired gag reflex, consideration should be given to administering activated charcoal via nasogastric tube once the airway is protected.
Haemodialysis may be useful in patients with severe toxicity or those with significant renal impairment (see Section 4.2 Dose and Method of Administration, Renal impairment). Standard haemodialysis procedures result in significant clearance of pregabalin (approximately 50% in 4 hours). Emesis is not recommended because of the potential for CNS depression and seizures.
For information on the management of an overdose, contact the Poisons Information Centre on 131126 (Australia).

7 Medicine Schedule (Poisons Standard)

S4.

6 Pharmaceutical Particulars

6.1 List of Excipients

Lactose monohydrate, maize starch, purified talc, gelatin, purified water, titanium dioxide, sodium lauryl sulfate, colloidal anhydrous silica. The proprietary ingredients TekPrint SW-9009 Black Ink and TekPrint SW-9008 Black Ink. The 75 mg, 100 mg, 200 mg, 225 mg and 300 mg capsules also contain iron oxide red.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C.

6.5 Nature and Contents of Container

Lyrica 25 mg capsules: packaged in PVC/Al blister packs or HDPE bottles of 14, 20, 56 and 60 capsules.
Lyrica 50 mg capsules: packaged in PVC/Al blister packs or HDPE bottles with Polypropylene CRC closures of 14, 20, 56 and 60 capsules.
Lyrica 75 mg capsules: packaged in PVC/Al blister packs or HDPE bottles with Polypropylene CRC closures of 14, 20, 56 and 60 capsules.
Lyrica 100 mg capsules: packaged in PVC/Al blister packs or HDPE bottles with Polypropylene CRC closures of 14, 20, 56 and 60 capsules.
Lyrica 150 mg capsules: packaged in PVC/Al blister packs or HDPE bottles with Polypropylene CRC closures of 14, 20, 56 and 60 capsules.
Lyrica 200 mg capsules: packaged in PVC/Al blister packs or HDPE bottles with Polypropylene CRC closures of 14, 20, 56 and 60 capsules.
Lyrica 225 mg capsules: packaged in PVC/Al blister packs or HDPE bottles with Polypropylene CRC closures of 14, 20, 56 and 60 capsules.
Lyrica 300 mg capsules: packaged in PVC/Al blister packs or HDPE bottles with Polypropylene CRC closures of 14, 20, 56 and 60 capsules.
Not all strengths or pack sizes are being distributed in Australia.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

Summary Table of Changes