Pregabalin, sold under the brand names Axalid and Lyrica among others, is an anticonvulsant, analgesic, and anxiolytic amino acid medication used to treat epilepsy, neuropathic pain, fibromyalgia, restless legs syndrome, opioid withdrawal, generalized anxiety disorder (GAD), and postherpetic neuralgia (a type of nerve damage that can result from shingles).[14][15][16] Pregabalin also has antiallodynic properties.[17][18][19] Its use in epilepsy is as an add-on therapy for partial seizures
| pregnancy au | D |
|---|
| pregnancy au comment | ‡R2R‡‡R3R‡ |
|---|
| dependency liability | Physical: High Psychological: Moderate |
|---|
| addiction liability | Low (but varying with dosage and route of administration) |
|---|
| routes of administration | By mouth |
|---|
| class | Gabapentinoid · Anticonvulsant · GABA analogue |
|---|
| atc prefix | N02 |
|---|
| atc suffix | BF02 |
|---|
| legal au | S4 |
|---|
| legal au comment | ‡R4R‡ |
|---|
| legal br | C1 |
|---|
| legal br comment | ‡R5R‡ |
|---|
| legal ca | Rx-only |
|---|
| legal nz | Rx-only |
|---|
| legal nz comment | ‡R6R‡ |
|---|
| legal uk | Class C |
|---|
| legal uk comment | ‡R7R‡ |
|---|
| legal us | Schedule V |
|---|
| legal eu | Rx-only |
|---|
| legal eu comment | ‡R8R‡ |
|---|
| legal status | SE: Förteckning V‡R9R‡ In general: Prescription only |
|---|
| bioavailability | Oral: ≥90% |
|---|
| protein bound | <1% |
|---|
| metabolism | Less than 2% is metabolized‡R10R‡ |
|---|
| metabolites | N-methylpregabalin |
|---|
| onset | May occur within a week (pain) |
|---|
| elimination half-life | 4.5–7 hours‡R11R‡ (mean 6.3 hours)‡R11R‡‡R12R‡ |
|---|
| duration of action | 8–12 hours ‡R13R‡ |
|---|
| excretion | Kidney |
|---|
| cas number | 148553-50-8 |
|---|
| pubchem | 5486971 |
|---|
| drugbank | DB00230 |
|---|
| chemspiderid | 4589156 |
|---|
| unii | 55JG375S6M |
|---|
| kegg | D02716 |
|---|
| chebi | 64356 |
|---|
| chembl | 1059 |
|---|
| synonyms | 3-Isobutyl-GABA; (S)-3-Isobutyl-γ-aminobutyric acid; Isobutylgaba; CI-1008; PD-144723 |
|---|
| iupac name | (3S)-3-(aminomethyl)-5-methylhexanoic acid |
|---|
| c | 8 |
|---|
| h | 17 |
|---|
| n | 1 |
|---|
| o | 2 |
|---|
| smiles | CC(C)CC(CC(=O)O)CN |
|---|
| stdinchi | 1S/C8H17NO2/c1-6(2)3-7(5-9)4-8(10)11/h6-7H,3-5,9H2,1-2H3,(H,10,11)/t7-/m0/s1 |
|---|
| stdinchikey | AYXYPKUFHZROOJ-ZETCQYMHSA-N |
|---|
Common side effects can include headache, dizziness, sleepiness, euphoria, confusion, trouble with memory, poor coordination, dry mouth, problems with vision, and weight gain. Serious side effects may include angioedema, kidney damage, and seizures.[21]
As with all other drugs approved by the FDA for treating epilepsy, the pregabalin labeling warns of an increased suicide risk when combined with other drugs.[22][23] When pregabalin is taken at high doses over a long period of time, addiction may occur, but if taken at usual doses the risk is low.[24] Use during pregnancy or breastfeeding is of unclear safety.[25]
It is a gabapentinoid medication which is a class of drugs within the derivatives of γ-aminobutyric acid (GABA analogues), an inhibitory neurotransmitter.[26][27][28][29] Although pregabalin is inactive at GABA receptors and GABA synapses, it acts by binding specifically to the α2δ-1 protein that was first described as an auxiliary subunit of voltage-gated calcium channels.[23][30][31]
Pregabalin was approved for medical use in the United States in 2004.[23] In the US, pregabalin is a Schedule V controlled substance under the Controlled Substances Act of 1970,[23] which means that the drug has low abuse potential compared to substances in Schedules I-IV, however, there is still a potential for misuse.[32] It is available as a generic medication.[33][34][35][36][37] In 2023, it was the 78th most commonly prescribed medication in the United States, with more than 8million prescriptions.[38][39]
For drug-resistant focal epilepsy, pregabalin is useful as an add-on therapy to other treatments.[40] Its use alone is less effective than some other seizure medications.[41] It is unclear how it compares to gabapentin for this use.[41]
The European Federation of Neurological Societies recommends pregabalin as a first-line agent for the treatment of pain associated with diabetic neuropathy, post-herpetic neuralgia, and central neuropathic pain.[42] A minority obtain substantial benefit, and a larger number obtain moderate benefit.[43] It is given equal weight as gabapentin and tricyclic antidepressants as a first-line agent, however, the latter are less expensive as of 2010.[44] Pregabalin is as effective at relieving pain as duloxetine and amitriptyline. Combination treatment of pregabalin and amitriptyline or duloxetine offers additional pain relief for people whose pain is not adequately controlled with one medication and is safe.[45][46]
Studies have shown that higher doses of pregabalin are associated with greater efficacy.[47]
Pregabalin's use in cancer-associated neuropathic pain is controversial,[48] though such use is common.[49] It has been examined for the prevention of post-surgical chronic pain, but its utility for this purpose is controversial.[50][51]
Pregabalin is generally not regarded as efficacious in the treatment of acute pain.[43] In trials examining the utility of pregabalin for the treatment of acute post-surgical pain, no effect on overall pain levels was observed, but people did require less morphine and had fewer opioid-related side effects.[50][52] Several possible mechanisms for pain improvement have been discussed.[53]
Pregabalin is effective for treatment of generalized anxiety disorder.[54] It is also effective for the short- and long-term treatment of social anxiety disorder and in reducing preoperative anxiety.[55][56] However, there is concern regarding pregabalin's off-label use due to the lack of strong scientific evidence for its efficacy in multiple conditions and its proven side effects.[57]
The World Federation of Biological Psychiatry recommends pregabalin as one of several first line agents for the treatment of generalized anxiety disorder, but recommends other agents such as those of the selective serotonin reuptake inhibitor (SSRI) class as first line treatment for obsessive–compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).[58][59]
Pregabalin has anxiolytic effects similar to benzodiazepines with less risk of dependence. The effects of pregabalin appear within one week of use,[60] and are similar in effectiveness to lorazepam, alprazolam, and bromazepam, but pregabalin has demonstrated superiority by producing more consistent therapeutic effects for psychosomatic anxiety symptoms. Long-term trials have shown continued effectiveness without the development of tolerance, and, in addition, unlike benzodiazepines, it has a beneficial effect on sleep and sleep architecture, characterized by the enhancement of slow-wave sleep. It produces less severe cognitive and psychomotor impairment compared to benzodiazepines.[61][62]
A 2019 review found that pregabalin reduces symptoms, and was generally well tolerated.[54]
Although pregabalin is sometimes prescribed for people with bipolar disorder, there is no evidence showing that it is effective.[56][63]
There is no evidence and significant risk in using pregabalin for sciatica and low back pain.[64][65][66]
Evidence of benefit in alcohol withdrawal as well as withdrawal from certain other drugs is limited as of 2016.[67]
In a systematic review analysing data from 5 cohort studies having 1,085,488 patients, use of gabapentinoids (pregabalin and gabapentin) was associated with an increased risks of thrombotic events (deep venous thrombosis and pulmonary thrombo-embolism) as early as three months of use, and with increased risk of cardiovascular events on prolonged use of more than a year duration. Heart failure was not increased with the use of gabapentinoids.[70]
Exposure to pregabalin is associated with weight gain, drowsiness, fatigue, dizziness, vertigo, leg swelling, disturbed vision, loss of coordination, and euphoria.[71] It has an adverse effect profile similar to other central nervous system (CNS) depressants. Even though pregabalin is a depressant and anticonvulsant, it can sometimes paradoxically induce seizures, particularly in large overdoses.[72] Adverse drug reactions associated with the use of pregabalin include:[73][74][75]
Cases of recreational use, with associated adverse effects, have been reported.[77]
Following abrupt or rapid discontinuation of pregabalin, some people reported symptoms suggestive of physical dependence. The FDA determined that the substance dependence profile of pregabalin, as measured by a personal physical withdrawal checklist, was quantitatively less than benzodiazepines. Even people who have discontinued short-term use of pregabalin have experienced withdrawal symptoms including insomnia, headache, heart palpitations, nausea, anxiety, diarrhea, flu-like symptoms, major depression, pain, seizures, excessive sweating, muscle twitching, and dizziness.[78]
A tapered discontinuation is recommended to reduce the chances of withdrawal symptoms. Lyrica's US package insert recommends a taper period of at least one week.[79] Best Practice Advocacy Centre New Zealand[80]
An overdose of pregabalin usually consists of severe drowsiness, severe ataxia, blurred vision, slurred speech, uncontrollable jerking motions (myoclonus), and anxiety.[89] In one case study, macular detachment was reported with overdose[90] Despite these symptoms an overdose is not usually fatal unless mixed with another CNS depressant. Several people with kidney failure developed myoclonus while receiving pregabalin, apparently as a result of the gradual accumulation of the drug. Acute overdosage may be manifested by drowsiness, tachycardia, and hypertonia. Plasma, serum, or blood concentrations of pregabalin may be measured to monitor therapy or to confirm a diagnosis of poisoning in hospitalized people.[91][92][93]
No drug interactions have been demonstrated in vivo. However, the manufacturer notes potential pharmacological interactions with opioids, benzodiazepines, barbiturates, ethanol (alcohol), and other central nervous system depressants. Concurrent use of ACE inhibitors and pregabalin may increase the risk of angioedema. Pregabalin may also enhance the fluid-retaining effects of certain antidiabetic agents, such as thiazolidinediones.[94]
Pregabalin may independently increase the risk of angioedema, and this risk is further elevated when used in combination with other drugs known to increase the likelihood of angioedema. These include, but are not limited to, certain L-type calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers, and other agents that inhibit the renin–angiotensin–aldosterone system.[95]
Pregabalin can also cause rare but serious adverse effects,[96] particularly when used in combination with other CNS depressants.[97][98]
Pregabalin is a member of the gabapentinoid class, also known as α2δ ligands. Despite being a structural analog of γ-aminobutyric acid (GABA), pregabalin is inactive at GABA receptors and does not mimic GABA.[26][27][28][29] Instead, its action involves binding to a specific site on the α2δ-1 protein and reducing the release of excitatory neurotransmitters in synapses.
Pregabalin does not directly block calcium channels (it is not a calcium channel blocker), as it does not bind to the ion conducting channel protein, called α1. However, in vitro studies show that pregabalin can reduce the normal traffic of calcium channels from intracellular sites (where they do not function) to membrane sites where they are functional.[23][30]
While the mechanism of action of pregabalin is not definitively characterized, its action in animal models of pain, seizures and anxiety requires binding to the α2δ-1 protein.[99] It has been found that this binding inhibits several actions of α2δ-1 and also inhibits the release of excitatory neurotransmitters. These excitatory neurotransmitters include glutamate, norepinephrine (noradrenaline), serotonin, dopamine, substance P, and calcitonin gene-related peptide.[100] By inhibiting the release of these neurotransmitters, pregabalin reduces excess activity of neuron networks, which helps alleviate symptoms and provides relief for patients experiencing pain, seizures, or other related symptoms.[101]
There are two drug-binding α2δ subunits, α2δ-1 and α2δ-2, and pregabalin shows similar affinity for (and hence lack of selectivity between) these two sites.[30] Pregabalin is selective in its binding to the α2δ VGCC subunits and does not bind significantly to other known drug receptors.[102][29]
Despite the fact that pregabalin is a GABA analogue,[103] it does not bind to GABA receptors, does not convert into GABA or another GABA receptor agonist in vivo, and does not directly modulate GABA transport or metabolism.[31][102]
Pregabalin is absorbed from the intestines by an active transport process mediated via the large neutral amino acid transporter 1 (LAT1, SLC7A5), a transporter for amino acids such as L -leucine and L -phenylalanine.[30][102][110] Very few (less than 10 drugs) are known to be transported by this transporter.[111] Unlike gabapentin, which is transported solely by the LAT1,[110][112]
Pregabalin is absorbed from the intestines by an active transport process mediated via the large neutral amino acid transporter 1 (LAT1, SLC7A5), a transporter for amino acids such as L -leucine and L -phenylalanine.[30][102][110] Very few (less than 10 drugs) are known to be transported by this transporter.[111] Unlike gabapentin, which is transported solely by the LAT1,[110][112] pregabalin seems to be transported not only by the LAT1 but also by other carriers.[30]
Pregabalin crosses the blood–brain barrier and enters the central nervous system.[102] However, due to its low lipophilicity,[112] pregabalin requires active transport across the blood–brain barrier.[110][102][114][115] The LAT1 is highly expressed at the blood–brain barrier[116] and transports pregabalin across into the brain.[110]
Pregabalin undergoes little or no metabolism.[112][30][117] In experiments using nuclear medicine techniques, it was revealed that approximately 98% of the radioactivity recovered in the urine was unchanged pregabalin.[113] The main metabolite is N-methylpregabalin.[113]
Pregabalin is generally safe in patients with liver cirrhosis.[118]
Pregabalin is eliminated by the kidneys in the urine, mainly in its unchanged form.[112][113] It has a relatively short elimination half-life, with a reported value of 6.3 hours.[112] Because of its short elimination half-life, pregabalin is administered 2 to 3 times per day to maintain therapeutic levels.[112] The kidney clearance of pregabalin is 73 mL/minute.[119]
Pregabalin is a GABA analogue that is a 3-substituted derivative as well as a γ-amino acid.[17][29] Because of its chemical and pharmacological similarities to gabapentin, it is sometimes called a gabapentinoid drug. Specifically, pregabalin is (S)-(+)-3-isobutyl-GABA.[120][121][122] Pregabalin also closely resembles the α-amino acids L -leucine and L -isoleucine, and this may be of greater relevance in relation to its pharmacodynamics than its structural similarity to GABA.[27][105][120]
Pregabalin was synthesized in 1990 as an anticonvulsant that was developed as a successor to the related gabapentin.[125] It was first synthesized by medicinal chemist Richard Bruce Silverman at Northwestern University in Evanston, Illinois.[126] During 1988 to 1990, Ryszard Andruszkiewicz, a visiting research fellow, synthesized a series of molecules requested by Silverman.[127] Upon testing in mouse seizure models by collaborators at Parke-Davis Pharmaceuticals,[128] one looked particularly promising. In vitro, it activated L-glutamic acid decarboxylase, an enzyme, but this later proved to be unimportant to prevention of seizures. Silverman had originally hoped that the enzyme would increase the production of the inhibitory neurotransmitter GABA and block convulsions.[129] After extensive development studies and clinical trials by Parke-Davis the drug was approved in the European Union in 2004. The US received FDA approval for use in treating epilepsy, diabetic neuropathic pain, and postherpetic neuralgia in December 2004. Pregabalin then appeared on the US market under the brand name Lyrica in the fall of 2005.[130] In 2017, the FDA approved pregabalin extended-release Lyrica CR for the management of neuropathic pain associated with diabetic peripheral neuropathy, and postherpetic neuralgia.[131] However, unlike the immediate release formulation, Lyrica CR was not approved for the management of fibromyalgia or as add-on therapy for adults with partial onset seizures.[132][119]
In the United States, the FDA has approved pregabalin for adjunctive therapy for adults with partial onset seizures, management of postherpetic neuralgia and neuropathic pain associated with spinal cord injury and diabetic peripheral neuropathy, and the treatment of fibromyalgia.[146] Pregabalin has also been approved in the European Union, the United Kingdom, and Russia for treatment of generalized anxiety disorder.[61][147]
Pregabalin is available as a generic medication in a number of countries, including the United States as of July 2019.[33][34][148] In the United States as of July 2019 the wholesale/pharmacy cost for generic pregabalin is US$0.17–0.22 per 150 mg capsule.[149]
From 2008 until 2018, Pfizer engaged in extensive direct-to-consumer advertising campaigns to promote its branded product Lyrica for fibromyalgia and diabetic nerve pain indications. In January 2016, the company spent a record amount, $24.6 million for a single drug on TV ads, reaching global revenues of $14 billion, more than half in the United States.[150]
Up until 2009, Pfizer promoted Lyrica for other uses that had not been approved by medical regulators. For Lyrica and three other drugs, Pfizer was fined a record amount of US$2.3
Northwestern University in the US holds the patent on pregabalin, exclusively licensed to Pfizer.[154][155] That patent, along with others, was challenged by generic manufacturers and was upheld in 2014, giving Pfizer exclusivity for Lyrica in the US until 2018.[156][157]
Pfizer's main patent for Lyrica, for seizure disorders, in the UK expired in 2013. In November 2018, the Supreme Court of the United Kingdom ruled that Pfizer's second patent on the drug, for the treatment of pain, was invalid because there was a lack of evidence for the conditions it covered – central and peripheral neuropathic pain. From October 2015, GPs were forced to change people from generic pregabalin to branded until the second patent ran out in July 2017. This cost the NHS £502 million.[158]
As of October 2017, pregabalin is marketed under many brand names: Algerika, Alivax, Alyse, Alzain, Andogablin, Aprion, Averopreg, Axual, Balifibro, Brieka, Clasica, Convugabalin, Dapapalin, Dismedox, Dolgenal, Dolica, Dragonor, Ecubalin, Epica, Epiron, Gaba-P, Gabanext, Gabarol, Gabica, Gablin, Gablovac, Gabrika, Gavin, Gialtyn, Glonervya, Helimon, Hexgabalin, Irenypathic, Kabian, Kemirica, Kineptia, Lecaent, Lingabat, Linprel, Lyribastad, Lyric, Lyrica, Lyrineur, Lyrolin, Lyzalon, Martesia, Maxgalin, Mystika, Neuragabalin, Neugaba, Neurega, Neurica, Neuristan, Neurolin, Neurovan, Neurum, Newrica, Nuramed, Paden, Pagadin, Pagamax, Painica, Pevesca, PG, Plenica, Pragiola, Prebalin, Prebanal, Prebel, Prebictal, Prebien, Prefaxil, Pregaba, Pregabalin, Pregabalina, Pregabaline, Prégabaline, Pregabalinum, Pregabateg, Pregaben, Pregabid, Pregabin, Pregacent, Pregadel, Pregagamma, Pregalex, Pregalin, Pregalodos, Pregamid, Pregan, Preganerve, Pregastar, Pregatrend, Pregavalex, Pregdin Apex, Pregeb, Pregobin, Prejunate, Prelin, Preludyo, Prelyx, Premilin, Preneurolin, Prestat, Pretor, Priga, Provelyn, Regapen, Resenz, Rewisca, Serigabtin, Symra, Vronogabic, Xablin, and Xil.[159]
It is marketed as a combination drug with mecobalamin under the brand names Agemax-P, Alphamix-PG, Freenerve-P, Gaben, Macraberin-P, Mecoblend-P, Mecozen-PG, Meex-PG, Methylnuron-P, Nervolin, Nervopreg, Neurica-M, Neuroprime-PG, Neutron-OD, Nuroday-P, Nurodon-PG, Nuwin-P, Pecomin-PG, Prebel-M, Predic-GM, Pregacent-M, Pregamet, Preganerv-M, Pregeb-M OD, Pregmic, Prejunate Plus, Preneurolin Plus, Pretek-GM, Rejusite, Renerve-P, Safyvit-PR, Vitcobin-P, and Voltanerv with Methylcobalamin and ALA by Cogentrix Pharma.[159]
In the US, Lyrica is marketed by Viatris
Pregabalin has anxiolytic effects similar to benzodiazepines with less risk of dependence. The effects of pregabalin appear within one week of use,[60] and are similar in effectiveness to lorazepam, alprazolam, and bromazepam, but pregabalin has demonstrated superiority by producing more consistent therapeutic effects for psychosomatic anxiety symptoms. Long-term trials have shown continued effectiveness without the development of tolerance, and, in addition, unlike benzodiazepines, it has a beneficial effect on sleep and sleep architecture, characterized by the enhancement of slow-wave sleep. It produces less severe cognitive and psychomotor impairment compared to benzodiazepines.[61][62]
A 2019 review found that pregabalin reduces symptoms, and was generally well tolerated.[54]
A 2025 review found possible benefits to sleep quality in patients with fibromyalgia.[69]
It is unclear if it is safe for use in pregnancy with some studies showing potential harm.[82]
In December 2019, the US Food and Drug Administration (FDA) warned about serious breathing issues for those taking gabapentin or pregabalin when used with central nervous system (CNS) depressants or for those with lung problems.[83][84]
The FDA required new warnings about the risk of respiratory depression to be added to the prescribing information of the gabapentinoids.[83] The FDA also required the drug manufacturers to conduct clinical trials to further evaluate their abuse potential, particularly in combination with opioids, because misuse and abuse of these products together is increasing, and co-use may increase the risk of respiratory depression.[83]
Among 49 case reports submitted to the FDA over the five-year period from 2012 to 2017, twelve people died from respiratory depression with gabapentinoids, all of whom had at least one risk factor.[83]
The FDA reviewed the results of two randomized, double-blind, placebo-controlled clinical trials in healthy people, three observational studies, and several studies in animals.[83] One trial showed that using pregabalin alone and using it with an opioid pain reliever can depress breathing function.[83] The other trial showed gabapentin alone increased pauses in breathing during sleep.[83] The three observational studies at one academic medical center showed a relationship between gabapentinoids given before surgery and respiratory depression occurring after different kinds of surgeries.[83] The FDA also reviewed several animal studies that showed pregabalin alone and pregabalin plus opioids can depress respiratory function.[83]
Pregabalin has potential for recreational use and abuse. It possesses a relatively wide therapeutic index and margin of safety compared to other central nervous system (CNS) depressants, and its effects may include euphoria, anxiolysis, and sedation.
Although generally considered to have low abuse potential, reports describe pregabalin inducing sensations of euphoria, calmness, excitement, and a "high" comparable to that of cannabis. These effects may contribute to the development of substance dependence, and withdrawal symptoms can occur if the medication is stopped abruptly.[85][86]
While pregabalin and cannabis share certain effects, such as CNS depressant and orexigenic (appetite-stimulating) properties, they differ significantly in their pharmacodynamics. Cannabis is primarily an anxiogenic substance with mild psychedelic effects, whereas pregabalin is an anxiolytic agent associated with mild euphoria that is prone to rapid tolerance.[87][88]
Recently, the α2δ-1 protein has been found (independent of calcium channels) to associate directly with certain NMDA-type glutamate receptors, some AMPA-type glutamate receptors and also with the extracellular matrix protein, thrombospondin, and to modulate the function of these proteins.[99] This has been proposed to contribute to the analgesic action of pregabalin animal models and in clinical use.
The endogenous α-amino acids L -leucine and L -isoleucine, which closely resemble pregabalin and the other gabapentinoids in chemical structure, are apparent ligands of the α2δ VGCC subunit with similar affinity as the gabapentinoids (e.g., IC50=71 nM for L -isoleucine), and are present in human cerebrospinal fluid at micromolar concentrations (e.g., 12.9 μM for L -leucine, 4.8 μM for L -isoleucine).[27] It has been theorized that they may be the endogenous ligands of the subunit and that they may competitively antagonize the effects of gabapentinoids.[27][105] In accordance, while gabapentinoids like pregabalin and gabapentin have nanomolar affinities for the α2δ subunit, their potencies in vivo are in the low micromolar range, and competition for binding by endogenous L -amino acids has been said to likely be responsible for this discrepancy.[104]
Pregabalin was found to possess 6-fold higher affinity than gabapentin for α2δ subunit-containing VGCCs in one study.[106][107] However, another study found that pregabalin and gabapentin had similar affinities for the human recombinant α2δ-1 subunit (Ki=32 nM and 40 nM, respectively).[108] In any case, pregabalin is 2 to 4 times more potent than gabapentin as an analgesic[103] and, in animals, appears to be 3 to 10 times more potent than gabapentin as an anticonvulsant.[103][109]
The oral bioavailability of pregabalin is greater than or equal to 90% across and beyond its entire clinical dose range (75 to 600 mg/day).[112] Food does not significantly influence the oral bioavailability of pregabalin.[112] Pregabalin is rapidly absorbed when administered on an empty stomach, with a Tmax (time to peak levels) of generally less than or equal to 1 hour at doses of 300 mg or less.[30][113] However, food has been found to substantially delay the absorption of pregabalin and to significantly reduce peak levels without affecting the bioavailability of the drug; Tmax values for pregabalin of 0.6 hours in a fasted state and 3.2 hours in a fed state (5-fold difference), and the Cmax is reduced by 25–31% in a fed versus fasted state.[112]
Pregabalin crosses the blood–brain barrier and enters the central nervous system.[102] However, due to its low lipophilicity,[112] pregabalin requires active transport across the blood–brain barrier.[110][102][114][115] The LAT1 is highly expressed at the blood–brain barrier[116] and transports pregabalin across into the brain.[110][102][114][115] Pregabalin has been shown to cross the placenta in rats and is present in the milk of lactating rats.[113] In humans, the volume of distribution of an orally administered dose of pregabalin is approximately 0.56 L/kg.[113] Pregabalin is not significantly bound to plasma proteins (<1%).[112]
Pregabalin undergoes little or no metabolism.[112][30][117] In experiments using nuclear medicine techniques, it was revealed that approximately 98% of the radioactivity recovered in the urine was unchanged pregabalin.[113] The main metabolite is N-methylpregabalin.[113]
Pregabalin is generally safe in patients with liver cirrhosis.[118]
Pregabalin is eliminated by the kidneys in the urine, mainly in its unchanged form.[112][113] It has a relatively short elimination half-life, with a reported value of 6.3 hours.[112] Because of its short elimination half-life, pregabalin is administered 2 to 3 times per day to maintain therapeutic levels.[112] The kidney clearance of pregabalin is 73 mL/minute.[119]
The oral bioavailability of pregabalin is greater than or equal to 90% across and beyond its entire clinical dose range (75 to 600 mg/day).[112] Food does not significantly influence the oral bioavailability of pregabalin.[112] Pregabalin is rapidly absorbed when administered on an empty stomach, with a Tmax (time to peak levels) of generally less than or equal to 1 hour at doses of 300 mg or less.[30][113] However, food has been found to substantially delay the absorption of pregabalin and to significantly reduce peak levels without affecting the bioavailability of the drug; Tmax values for pregabalin of 0.6 hours in a fasted state and 3.2 hours in a fed state (5-fold difference), and the Cmax is reduced by 25–31% in a fed versus fasted state.[112]
