Pregabalin in the Hands of a General Practitioner

Pregabalin is not only prescribed in neurology departments and clinics. General practitioners also often encounter conditions treated with this drug in their practice, particularly diabetic neuropathy and postherpetic neuralgia. How does pregabalin fare in these indications according to a 2019 systematic review?

Data to Rely On

The mentioned review included data from 45 double-blind randomized controlled trials, encompassing a total of 11,906 participants. The selected studies, published between January 2009 and April 2018, followed patients for at least 2 weeks and compared pregabalin with placebo or other neuropathic pain therapies. In all these studies, patients rated the intensity of their pain.

Painful Diabetic Neuropathy

Diabetic neuropathy is a serious complication of diabetes that significantly increases morbidity and worsens the quality of life for patients. The painful form of peripheral neuropathy is difficult to treat. According to most recommended guidelines, pregabalin is the first-line drug for painful diabetic neuropathy. Its effect depends on the dose. Treatment usually starts with 75 mg at night, increasing to 150 mg/day after 1–2 weeks, and further titration based on effect and tolerance.

The systematic review confirmed the effect of pregabalin in this indication. For painful diabetic neuropathy, taking 300 mg of pregabalin per day reduced the intensity of pain by at least 30% in 47% of patients (versus 42% taking placebo; 8 studies with 2,320 participants). A reduction in pain intensity by at least 50% was achieved by pregabalin at the same dosage in 31% of patients (versus 24% taking placebo; 11 studies with 2,931 participants).

A daily dose of 600 mg of pregabalin reduced pain intensity by at least 30% in 63% of patients (compared to 52% taking placebo; 2 studies with 611 participants) and by at least 50% in 41% of patients (compared to 28% taking placebo; 5 studies with 1,015 participants).

Postherpetic Neuralgia

Postherpetic neuralgia is a common type of peripheral neuropathy. Its incidence increases with age; common symptoms include intense pain, itching, and increased sensitivity to touch. It is one of the primary indications for pregabalin treatment.

Several studies addressed this issue between 2009 and 2018. An analysis of data from 3 double-blind randomized controlled trials with a total of 589 participants revealed that at least 300 mg of pregabalin led to a reduction in pain intensity by at least 30% in 50% of patients (versus 25% taking placebo). This dosage led to a reduction in pain by at least 50% in 32% of patients (versus 13% taking placebo; 4 studies with 713 participants).

A daily dose of 600 mg of pregabalin reduced pain intensity by at least 30% in 62% of patients (compared to 24% taking placebo; 3 studies with 537 participants) and by at least 50% in 41% of patients (compared to 15% taking placebo; 4 studies with 732 participants).

Pregabalin Can Also Be Prescribed by General Practitioners

General practitioners can prescribe pregabalin for central and peripheral neuropathic pain. They encounter neuropathic pain mainly in diabetic neuropathy and postherpetic neuralgia – conditions pregabalin is effective against. Additionally, it improves sleep, alleviates anxiety and depression, is well tolerated, and can be titrated to an effective dose relatively quickly. In approved indications, pregabalin has a favorable safety profile, and data also support its cost-effectiveness. Due to minimal drug interactions, pregabalin is also suitable for combination therapy.

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Source: Derry S., Bell R. F., Straube S. et al. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev 2019 Jan 23; 1: CD007076, doi: 10.1002/14651858.CD007076.pub3.