Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Pregabalin is an oral medication that is
chemically related to gabapentin
(Neurontin, Gabarone). It is used for treating pain caused by
neurologic diseases such as postherpetic neuralgia as well as
seizures. It also
is used for treating fibromyalgia. The mechanism of action of pregabalin is
unknown. Pregabalin binds to calcium channels on nerves and may modify the
release of neurotransmitters (chemicals that nerves use to communicate with each
other). Reducing communication between nerves may contribute to pregabalin's
effect on pain and seizures. The FDA approved pregabalin in December 2004.
STORAGE: Pregabalin should be stored at room temperature, between
15-30 C (59-86 F).
PRESCRIBED FOR: Pregabalin is used for neuropathic pain associated
with diabetic peripheral neuropathy or postherpetic neuralgia and in combination
with other drugs to treat partial onset seizures in adults. It also is used for
treating fibromyalgia.
DOSING: Pregabalin may be taken with or without food. The initial dose for neuropathic pain is 50 mg three times a day (150 mg/day). The dose may be increased to a maximum dose of 100 mg 3 times daily (300 mg/day) after one week.
The recommended dose for postherpetic neuralgia is 75-150 mg twice daily or 50-100 mg three times daily. Begin dosing at 75 mg two times a day or 50 mg three times a day (150 mg/day). The dose may be increased to 100 mg 3 times daily (300 mg/day) after one week. If pain relief is inadequate after 2-4 weeks of treatment at 300 mg/day, the dose may be increased to 300 mg twice daily or 200 mg three times daily. Doses greater than 300 mg cause more side effects.
The recommended dose for treating seizures is 150-600 mg/day divided into 2 or 3 doses, starting at at 150 mg daily and increasing based on response and tolerability.
Fibromyalgia is treated with 300-450 mg/day in 2 or 3 divided doses.
DRUG INTERACTIONS: Alcohol and drugs that cause sedation may increase
the sedative effects of pregabalin. Pioglitazone (Actos) and rosiglitazone
(Avandia) cause weight gain, fluid retention and possibly heart failure.
Therefore, combining pregabalin with these drugs may increase the occurrence of
weight gain and fluid retention.
PREGNANCY: There are no adequate studies of pregabalin in
pregnant
women.
NURSING MOTHERS: It is not known whether pregabalin is excreted in
human breast milk.
SIDE EFFECTS: The most common side effects of pregabalin are
dizziness, drowsiness, dry mouth, edema (accumulation of fluid), blurred vision,
weight gain, and difficulty concentrating. Other side effects include
reduced
blood platelet counts, and increased
blood creatinine kinase levels. Increased
creatinine kinase can be a sign of muscle injury, and in clinical trials three
patients experienced rhabdomyolysis (severe muscle injury). Therefore, patients
should report unexplained muscle pain, tenderness or weakness to their doctors,
especially if associated with fever and malaise (reduced well-being). Pregabalin
has rarely been associated with angioedema (swelling of the face, tongue, lips,
and gums, throat and larynx).
Antiepileptic medications have been associated
with increased risk of suicidal thinking and behavior. Anyone
considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are
started on therapy should be closely observed for clinical worsening, suicidal
thoughts, or unusual changes in behavior.
Shingles (herpes zoster) is a skin rash caused by the same virus that causes chickenpox. Under certain circumstances, such as emotional stress, immune deficiency, or with cancer, the virus re-activates causing shingles. Shingles are catching and can spread from an infected person to others who have not had chickenpox. There are a variety of treatments for shingles.
A pinched nerve can be caused of a variety of conditions, for example, carpal tunnel syndrome, herniated disc, sciatica, arthritis, spinal stenosis, trauma, and more. Common symptoms of a pinched nerve include pain, numbness, tingling, and weakness. Treatment of a pinched nerve depends on the cause of the pinched nerve.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Lumbar stenosis can be caused by degenerative arthritis (the most common cause), tumor, infection, or metabolic disorders (Paget's disease of the bone). Symptoms include low back pain, weakness, pain, numbness, and loss of sensation in the legs. Other conditions may cause similar symptoms of lumbar stenosis, including diabetic neuropathy, claudication, and peripheral vascular disease. Diagnosis, is a medical history and imaging studies. Lumbar stenosis may be treated with medication or surgery.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves outside the brain and spinal cord).
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
Few experiences match the drama of a convulsive seizure. A person having a severe seizure may cry out, fall to the floor
unconscious, twitch or move uncontrollably, drool, or even lose bladder control. Within minutes, the attack is over, and the person regains consciousness but is exhausted and dazed. This is the image most people have when they hear the word epilepsy. However, this type of seizure -- a
generalized tonic-clonic seizure -- is only one kind of epilepsy. There are many other kinds, each with a different set of symptoms.
Epilepsy was one of the first brain disorders to be described. It was mentioned in ancient Babylon more than 3,000 years ago. The strange behavior caused by some seizures has contributed through the ages to many superstitions and prejudices. The word epilepsy is derived from the Greek word for "attack." People once thought that those with epilepsy were being visited by demons or gods. However, in 400 B.C., the early...
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