Pregabalin: possibilities of pain therapy at the present stage

Pregabalin

For patients of any profile with moderate and severe pain syndrome (from 40 to 100 on the VAS-visual analogue pain scale), Pregabalin is indicated as a coanalgesic (adjuvant), i.e. a drug that does not have the category “analgesic” in the instructions, but by relieving anxiety, through improving sleep and influencing the mechanism of central sensitization (a source of excitation in the central nervous system that occurs after 3 hours of experiencing and feeling any pain and exists autonomously, even when pain impulses no longer arrive), allows you to achieve complete and rapid pain relief for the patient using lower dosages of narcotic analgesics (opioid-sparing effect). Another advantage of Pregabalin in comparison with other anticonvulsants is its hepatic safety (it is not metabolized in the liver and is excreted unchanged by the kidneys), the ability to quickly - within 7 days - achieve the average therapeutic and/or maximum dose, its effectiveness in cases where other drugs didn't work. The listed advantages of Pregabalin are enshrined in more than 50 treatment standards approved by the Ministry of Health of the Russian Federation in the following profiles: neurology, neurosurgery, oncology, rheumatology, etc., it is included in the guidelines for palliative care and the treatment of rheumatological patients. Physician competence is the key to safe and effective patient care.

I have been using the drug Pregabalin for more than 10 years. Today, in certain clinical situations, I can’t imagine how to manage without it. Most often, of course, such a need arises in the treatment of neuropathic pain syndrome, especially in combination with an anxiety disorder and in the treatment of pain syndromes in oncology. Pain syndromes in cancer patients are characterized by the fact that in most cases they are chronic (over 3 months), mixed in pathogenesis: nociceptive-neuropathic (the patient complains of aching tearing pain and experiences and describes sensations of numbness, burning, tingling, a feeling of electric current passing ), and are accompanied in up to 100% of cases by severe emotional disorders: anxiety and depression. For all of the listed manifestations of cancer pain syndrome, Pregabalin has direct indications, according to the instructions. The demonization of drugs containing Pregabalin (hype on numerous forums and addiction and dependence) is not justified by medical knowledge and experience and is supported by the lack of positive emotions and the severity of depression of those who create these reviews. Pain and anxiety itself are an antidote (antagonist) of those receptors and those mediators that are affected by Pregabalin, if it is used according to indications and justifiably.

Instructions for use of PREGABALIN-RICHTER

In some patients with diabetes mellitus, an increase in body weight during treatment with pregabalin may require dose adjustment of hypoglycemic drugs.

If symptoms of angioedema (such as facial swelling, perioral edema or upper respiratory tract swelling) develop, pregabalin should be discontinued.

During treatment with pregabalin, cases of dizziness and drowsiness have been reported, which increase the risk of accidental injury (falls) in elderly patients. There have also been reports of loss of consciousness, confusion and cognitive impairment. Therefore, patients should be advised to exercise caution until the possible side effects of treatment become clear.

In controlled studies, blurred vision was observed more frequently in patients receiving pregabalin than in patients receiving placebo. In most cases, vision was restored after discontinuation of the drug. In clinical studies that included ophthalmologic examination, the incidence of decreased visual acuity and visual field changes was higher among patients receiving pregabalin than among patients receiving placebo. The incidence of fundus examination changes was also higher with pregabalin than with placebo.

During post-marketing use of the drug, adverse reactions from the organ of vision were also observed, which included loss of vision, blurred vision or other changes, many of which were transient. When pregabalin therapy is discontinued, visual symptoms can be expected to resolve or decrease in severity.

There have been cases of renal failure; in some cases, after discontinuation of the drug, kidney function was restored.

There is insufficient information on the possibility of discontinuing other anticonvulsants after achieving seizure control with pregabalin, as well as the advisability of pregabalin monotherapy.

The following adverse events have been observed following discontinuation of pregabalin following long-term or short-term therapy:

• insomnia, headache, nausea, diarrhea, flu-like syndrome, anxiety, nervousness, depression, sweating, dizziness, convulsions. The patient should be informed of these symptoms when initiating treatment with pregabalin.

While using pregabalin or immediately after the end of therapy, seizures may develop, incl. status epilepticus and grand mal seizure.

There is evidence that after discontinuation of pregabalin after long-term use, the incidence and severity of withdrawal symptoms may be dose-dependent.

During post-marketing use of pregabalin, the development of chronic heart failure has been reported in some patients receiving pregabalin. These reactions were predominantly observed in elderly patients with impaired cardiovascular function and those receiving pregabalin for neuropathy. Therefore, pregabalin should be used with caution in this category of patients. After discontinuation of pregabalin, such reactions may disappear.

When treating central neuropathic pain due to spinal cord lesions, an increase in the frequency of adverse reactions from the central nervous system, such as drowsiness, was noted. This may be due to the additive effects of pregabalin and other concomitantly used drugs (eg, antispastic drugs). This circumstance should be taken into account when prescribing pregabalin for this indication.

Suicidal thoughts or behavior have been reported in patients receiving antiepileptic drugs for various indications. The results of a meta-analysis of randomized placebo-controlled trials of antiepileptic drugs indicated a small increase in the risk of suicidal thoughts and behavior. The mechanism of this effect is unknown, and available data do not allow us to exclude such a risk when using pregabalin. In this regard, patients receiving drugs in this group should be carefully monitored for the emergence of suicidal thoughts and behavior, and, if necessary, appropriate treatment should be prescribed. Patients and caregivers should be advised to seek medical attention if suicidal thoughts or behavior occur.

In post-marketing experience, there have been case reports of lower gastrointestinal dysfunction (eg, obstructive and paralytic ileus, constipation) during concomitant use of pregabalin with drugs that can cause constipation, such as opioid analgesics. When using pregabalin and opioid analgesics together, measures should be taken to prevent constipation (especially in women and elderly patients).

There are known cases of dependence development with the use of pregabalin. Patients with a history of drug dependence require close medical monitoring to identify symptoms of pregabalin dependence.

Cases of encephalopathy have been reported, especially in patients with concomitant diseases that could contribute to its development.

The drug contains lactose monohydrate, therefore patients suffering from rare hereditary diseases characterized by galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome should not take Pregabalin-Richter.

Impact on the ability to drive vehicles and operate machinery

Pregabalin-Richter may have a mild or moderate effect on the ability to drive vehicles and operate machinery. The drug Pregabalin-Richter can cause dizziness and drowsiness and, accordingly, affect the ability to drive vehicles and operate machinery. Patients should not drive or operate machinery or perform other potentially hazardous activities until it is clear whether this drug affects the ability to perform such tasks.

Treatment of drug addicts who use lyrica

Pregabalin is often prescribed to ease withdrawal symptoms. This is where drug addicts learn about the drug.

Few people are able to get rid of drug addiction on their own. If you find signs of dependence turning into drug addiction in yourself or a loved one, consult a doctor immediately.

The first stage of treatment is detoxification, i.e. cleansing the body. The doctor will prescribe procedures to relieve withdrawal symptoms and restore physical functions.

Next, a psychologist works with the patient. Psychological assistance is aimed at completely stopping the use of Lyrica and other drugs. Working with a psychologist is the most important part of treatment. The main cause of drug addiction is psychological and social problems. Under the influence of a drug, the patient hides from conflicts, traumas, and complexes.

It is important to be patient and complete your pregabalin treatment.

Relieving withdrawal symptoms and working with a psychologist are not considered a lifelong guarantee against addiction; constant monitoring is required.

Indications for taking pregabalin

• Neuralgia diabetic, postherpetic.
• Polyneuropathy with pain syndrome.
• Fibromyalgia.
• Myalgia (muscle pain).
• Inflammatory processes of the nervous system that occur with pain.
• Persistent pain that is unresponsive to traditional therapy.
• Epilepsy, convulsive syndrome.
• Generalized anxiety disorder.
• Withdrawal syndrome in addiction to psychoactive substances.

It is used in long courses of several weeks. It is practically not metabolized in the body (not included in metabolism) and is excreted unchanged in the urine.

Literature:

1. Issues of addiction. 2021. 2021, No. 1 (161). - 2021. - 159, [1] p. : table
2. Pharmacology of antiepileptic drugs: a textbook for students in specialty programs “General Medicine”, “Pediatrics”, “Pharmacy” / I. A. Vinogradova, V. D. Yunash, S. V. Goranskaya [etc.]; PetrSU Publishing House, 2021. - 32 p. : ill., table; ISBN 978-5-8021-3665-2
3. Bochanova, Elena Nikolaevna. Optimization of pharmacotherapy for epilepsy based on a personalized approach to assessing the safety of drugs: dissertation ... Doctor of Medical Sciences: 03.14.06 / Bochanova Elena Nikolaevna; [Place of protection: Ros. Peoples' Friendship University]. - Krasnoyarsk, 2021. - 207 p. : ill.
4. New pharmacy. 2021. 2021, No. 11. - 2021. - 112 p. : color ill., table.

Content:

1. Features of receiving lyrics
2. Duration of treatment with pregabalin
3. The dangers of exceeding the permissible dosage or frequency of taking Lyrica
4. Recommendations for minimizing harm from taking pregabalin

Pregabalin (Lyrica) is a fairly new drug, as it was synthesized in the USA only in 2004, and entered the European market three years later.
Initially, the drug was intended for the treatment of epileptic seizures, neuropathic pain and postherpetic neuralgic conditions. Drug addicts have learned to use the anticonvulsant and analgesic properties of the drug to obtain a cheap and quick euphoric effect. Now Lyrica should be considered in acceptable doses as a medicine, and in higher doses as a dangerous and popular drug.

Therefore, it is very important to know how long you can take pregabalin and in what quantities without harm to your health. All prescriptions are made only by a doctor; self-medication is very dangerous, since increased doses are addictive and lead to mental disorders and physical illnesses.

Signs of addiction

The first alarm bell is when a healthy person takes pills for non-medical purposes.

State of a person while taking the drug:

• laughter for no reason;
• wide pupils;
• reddened whites of the eyes;
• outbursts of aggression;
• uncontrollable repetitive body movements;
• increased appetite.

Symptoms of regular lyric use:

• the person “sways” and has difficulty standing on his feet;
• difficulty speaking, mooing;
• heavy sweating;
• mood swings from depression to euphoria;
• trembling hands;
• nausea, headache;
• problems with memory and attention;
• frequent cough without cold;
• insomnia.

Before diagnosing addiction, make sure symptoms are not caused by other drugs.

Features of receiving lyrics

This medication for relieving seizures and reducing neuropathic pain can be purchased at the pharmacy only with a prescription. There is no medicine available for open sale, but even schoolchildren and teenagers buy it on the black market and via the Internet.

The method of administration and dose is determined by the doctor, guided by the diagnosis, physical and mental condition, the results of a clinical examination, the severity of the disease, the age and gender of the patient. The patient’s main task is to strictly adhere to the doctor’s recommendations and immediately notify his doctor of the slightest deviation in health. In this case, it will be possible to achieve the maximum effect from the medication course and avoid negative manifestations.

The permissible daily dosage ranges from 150 to 600 mg. The specialist most often prescribes a minimum dose and observes the pharmacological effect, and if necessary, increases the amount after 7 days. The recommended portion of the drug is generally divided into 2 or 3 times and consumed regardless of meals.

Patients over 65 years of age and suffering from kidney and liver diseases are prescribed reduced doses of the drug. Adjustment of medication prescriptions may be necessary if severe side effects are detected and chronic ailments worsen.

Duration of treatment with pregabalin

The time of taking the drug is selected individually for each patient. Depending on the diagnosis and the effectiveness of the prescribed drug therapy, it can range from 1-2 weeks to several months. In severe cases of neuropathy and cancer pain, the course will be long, but it is recommended to use the drug for 14 days with constant monitoring of well-being and a subsequent break.

If you miss a dose, you should not take a double dose of the drug. It is necessary to take the medicine as quickly as possible, and it is better to postpone the next dose a little in time. You cannot stop using the medication very abruptly: it is necessary to reduce its amount gradually over one week. If you follow all the doctor's instructions, pregabalin will not cause any particular harm, with the exception of minor adverse reactions that disappear 7-14 days after the end of the treatment program.

Lyrica (pregabalin) is a drug

Initially, pregabalin was positioned as a safe, non-addictive drug. When they discovered that the drug reduced symptoms of anxiety and depression, the number of buyers increased.

Since 2010, doctors have diagnosed physical dependence on pregabalin. On June 1, 2012, a law was passed prohibiting the sale of pregabalin without a prescription. But unscrupulous sellers sell the product without any documents. There are no fines or penalties for purchasing or storing the drug. Only for sale without a prescription and illegal transportation.