LYRICA IN THE TREATMENT OF FIBROMYALGIA

Lyrica, the first treatment for neuropathic pain associated with Diabetic Peripheral Neuropathy, is indicated for the management of Fibromyalgia, Postherpetic Neuralgia, and as adjunctive therapy for adults with Partial Onset Seizures.

CHARACTERISTICS OF FIBROMYALGIA

v    Core symptom of fibromyalgia is chronic widespread pain, associated with diffuse tenderness

v    Patients demonstrate pain on palpation in at least 11 of 18 tender points

v    Fibromyalgia is believed to be a dysfunctional hyperexcitability in pain processing

MECHANISM OF ACTION OF LYRICA

v    Although the exact mechanism of action is unknown, results from animal models indicate that the analgesic effects of Lyrica may be associated with the following functions:

ü     Lyrica crosses the blood-brain barrier to bind to the 2-delta subunit to close presynaptic calcium channels diminishing excessive neuronal activity.

ü     Decreases the release of the excitatory neurotransmitter glutamate

ü     Decreases substance P

ü     May work in the central nervous system to reduce the level of perceived pain

ONSET OF ACTION

v    Can reduce neuropathic pain and anxiety in one week.  

METABOLISM

v    No liver metabolism

v    Hepatic impairment mandates no dose adjustment

v    Lyrica is excreted renally 

v    Can be removed by hemodialysis.

Dosing recommendations

v    Initial dose = 75 mg. twice daily 

v    At week one as needed increase to 150 mg. twice daily

v    Maximum dose = 225 mg twice daily (450 mg daily)

v    Discontinue gradually over minimum of one week

o      Flat pricing across dosage strengths

SIDE EFFECTS

v    Dizziness

v    Somnolence

v    Cognitive slowing, difficulty concentrating, or poor attention span

v    Fatigue

v    Dry mouth

v    Blurred vision

v    Weight gain

v    Edema

v    Patients with a creatinine clearance of 30 to 60 mL/min had a greater incidence of discontinuation due to adverse reactions than patients with normal creatinine clearance

Consults

Called for consult at SJRMC. BHU, in Navasota is about 35 miles from SJRMC making consults difficult. About the only thing dreadful about the recorders job. Lady had complications from gastric stapling surgery June 2007. Has been in hospital taking care of multiple surgical complications for 6 1/2 months so far. Was depressed and crying when seen a couple of days before. Placed her on Geodon 20 mg IM feeling better, but can't keep giving injections. Having trouble sleeping. Discontinued IM Geodon and started on Seroquel 20 mg--very low dose to improve sleep and also workup to therapeutic dose for depression. Placed on Remeron for depressing which will also help with sleep. Meds had to be given via GI tube.