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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by ed_uk on April 25, 2006, at 15:42:07
The official UK data sheet for Lyrica is now available online.
The recommended dose for GAD (generalised anxiety disorder) is as follows....
Generalised Anxiety Disorder
The dose range is 150 to 600 mg per day given as two or three divided doses. The need for treatment should be reassessed regularly.
Lyrica may be taken with or without food.
Pregabalin treatment can be started with a dose of 150 mg per day. Based on individual patient response and tolerability, the dosage may be increased to 300 mg per day after 1 week. Following an additional week the dosage may be increased to 450 mg per day. The maximum dosage of 600 mg per day may be achieved after an additional week.
Information RE withdrawal symptoms is provided....
After discontinuation of short-term and long-term treatment with pregabalin withdrawal symptoms have been observed in some patients. The following events have been mentioned: insomnia, headache, nausea, diarrhoea, flu syndrome, nervousness, depression, pain, sweating and dizziness. The patient should be informed about this at the start of the treatment.
Concerning discontinuation of long-term treatment of pregabalin there are no data of the incidence and severity of withdrawal symptoms in relation to duration of use and dosage of pregabalin.
Information RE clinical trials in GAD.....
Generalised Anxiety Disorder
Pregabalin has been studied in 6 controlled studies of 4-6 week duration, an elderly study of 8 week duration and a long-term relapse prevention study with a double blind relapse prevention phase of 6 months duration.
Relief of the symptoms of GAD as reflected by the Hamilton Anxiety Rating Scale (HAM-A) was observed by Week 1.
In controlled clinical trials (4-8 week duration) 52% of the pregabalin treated patients and 38% of the patients on placebo had at least a 50% improvement in HAM-A total score from baseline to endpoint.
The full data sheet is available here.....
http://emc.medicines.org.uk/emc/industry/default.asp?page=displaydoc.asp&documentid=14651
Ed
Posted by S.D. on April 29, 2006, at 1:49:21
In reply to Lyrica approved for GAD in UK - dosing guidelines, posted by ed_uk on April 25, 2006, at 15:42:07
Hi, I used to read and post considerably for a while in 2000 (same username -- unfortunate choice considering how google deals with (ignores) punctuation).
Have been relatively contentedly away from PBabble and taking clonazepam 1.5 mg/day (and self-directed and peer-group CBT at times) for the social anxiety. But things have changed, including can't get clonazepam anymore.
I've read about Lyrica (Pregabalin) here and I just started Lyrica for generalized social phobia (taking only at night so far, 75 mg -- concerned about side effects, which I had with short-lived trial of Neurontin years ago) and was informed today by my doc (nurse practitioner actually) that I was never going to be allowed more than 300 mg/day. That seems a bit stupid to me given that she has decided to prescribe it off-label (in USA it seems it is not approved for any anxiety) -- kind of like giving a broken crutch to someone with a broken leg.
Have there been any trials for Social Phobia/SAD at as little as 300 mg/day? The only one I found was 150 (==placebo) and 600 (signif > placebo).
Or, is there any evidence that another med could be usefully added to a dose of pregabalin that is insufficient by itself?
I know there have been some trials for general anxiety or GAD at <= 300 mg, but the GABA connection and dis-inhibition effect of e.g. clonazepam, Kava Kava, neurontin, and even somewhat Parnate, make me feel like SP/SAD is different.
Thanks for any comments. I wish I could say it is "good to be back" but you'll understand why I hoped I never would be.[*sigh*]
--not-as-SAD-anymore-but-still_shyInSanDiego
Posted by ed_uk on April 29, 2006, at 12:12:24
In reply to Lyrica/Pregabalin-Any social anx. action at 300mg?, posted by S.D. on April 29, 2006, at 1:49:21
Hello :)
Welcome back to babble!
>I was never going to be allowed more than 300 mg/day
Why not?
Ed
Posted by S.D. on April 29, 2006, at 14:27:47
In reply to Re: Lyrica/Pregabalin-Any social anx. action at 300mg? » S.D., posted by ed_uk on April 29, 2006, at 12:12:24
> Welcome back to babble!
Thanks!
> >I was never going to be allowed more than 300 mg/day
>
> Why not?
>
> EdI should clarify, I meant she said it won't happen at this corp. (PCSD for those who might know of it) or at the very least with the M.D. that seems to be looking over the shoulder of this N.P. by policy. This was by phone msg so I don't know why not. My only guess is that they don't want to deal with the side effects, which have been seen to be fairly likely in a dose-dependent way
(http://www.rxlist.com/cgi/generic4/lyrica_ad.htm -- not sure how this compares to what they have likely seen).shyAndAnxiousInSanDiego
Posted by ed_uk on April 29, 2006, at 16:24:48
In reply to Re: Lyrica/Pregabalin-Any social anx. action at 300mg? » ed_uk, posted by S.D. on April 29, 2006, at 14:27:47
Hi
Could you see the doctor rather than the nurse? You might be able to try a wider range of doses that way.
Ed
Posted by yxibow on May 1, 2006, at 17:24:24
In reply to Re: Lyrica/Pregabalin-Any social anx. action at 300mg? » ed_uk, posted by S.D. on April 29, 2006, at 14:27:47
> I should clarify, I meant she said it won't happen at this corp. (PCSD for those who might know of it) or at the very least with the M.D. that seems to be looking over the shoulder of this N.P. by policy. This was by phone msg so I don't know why not. My only guess is that they don't want to deal with the side effects, which have been seen to be fairly likely in a dose-dependent way
It is a brand new drug to be "experimented" by the psychiatric market here in the US. It may be only one carbon atom different from Neurontin but its side effects are significantly different, at least from my view (taken off label for adjunctive therapy for a complex anxiety disorder).
The two most disturbing one in my opinion is "asthenopia", or weak eyes -- more common is blurriness, but I dont quite have blurriness, I have weaker eyes at distances -- and cognitition issues. And this is at a fraction of what you are taking.
Granted, I have other medications on board and though it is not a P450 significant drug, we don't know the side effects or whether it crossreacts with the current Neurontin and other medications, etc.
Its a drug to be taken with caution, raised with caution and watched with caution. At least from my opinion. That doesn't mean that you shouldn't be a little more forward with your care provider but its something a psychopharmacologist should really be manipulating with. I've had what I could consider scary odd things happen so far, and I have given this drug hope. I do hope it will very slowly mitigate over time.
Anyhow, that is my 2cCheers
-- Jay
Posted by jakeman on May 1, 2006, at 20:39:22
In reply to Re: Lyrica/Pregabalin-Any social anx. action at 300mg? » S.D., posted by ed_uk on April 29, 2006, at 12:12:24
Hi Ed, and SD and xyibow.
I was recently prescribed Lyrica to help with sleep. I found it to be activating so I've taken it during the the day for the past two days. I have found it very helpful for social anxiety. It removes the inner tension that I usually feel all the time, and has a slight anti-depressant effect. I was highly skeptical about Lyrica since I tried Nuerontin and it was mind numbing. I'm hesistant to even post these comments because I'm afraid it will not last. For now though it's been great.
BTW Ed, I started Rozerem at the same time. It puts me to sleep but I still wake up after 3 or 4 hours. My sleep doctor seems to think that I should continue taking it for several weeks for the receptors to adjust. But I'm afraid that it will down regulate the melatonin receptors so that I'll have to take even more sleep medication. Any thoughts?
thanks,
Jake
Posted by ed_uk on May 2, 2006, at 14:22:19
In reply to Re: Lyrica/Pregabalin-Any social anx. action at 300mg? » ed_uk, posted by jakeman on May 1, 2006, at 20:39:22
Hi J
>I have found it very helpful for social anxiety. It removes the inner tension that I usually feel all the time, and has a slight anti-depressant effect.
That's good news :) What dose are you taking? Lyrica was recently approved in the UK (and the rest of the EU) for the treatment of generalised anxiety disorder. Here is some information on the dose........
Generalised Anxiety Disorder
The dose range is 150 to 600 mg per day given as two or three divided doses. The need for treatment should be reassessed regularly.
Pregabalin treatment can be started with a dose of 150 mg per day. Based on individual patient response and tolerability, the dosage may be increased to 300 mg per day after 1 week. Following an additional week the dosage may be increased to 450 mg per day. The maximum dosage of 600 mg per day may be achieved after an additional week.
>BTW Ed, I started Rozerem at the same time. It puts me to sleep but I still wake up after 3 or 4 hours
Rozerem isn't generally effective for maintaining sleep :( You may need additional medication to keep you asleep.
Regards
Ed
Posted by jakeman on May 2, 2006, at 20:18:22
In reply to Re: Lyrica/Pregabalin-Any social anx. action at 300mg? » jakeman, posted by ed_uk on May 2, 2006, at 14:22:19
Hi Ed,
I'm taking 75 mg of Lyrica right now. I take it mid-day, because it's in the late afternoon when the grim reaper of anxiety and depression swoops down on me. Today I got through several meetings feeling pretty well, when usually I get all nervous and frazzled. We'll see what happens, may have to up the dosage later. I agree with your comments about Rozerem. I wonder if its ok to take it twice a night, I need to read more about it mechanism of action.
warm regards, Jake
> Hi J
>
> >I have found it very helpful for social anxiety. It removes the inner tension that I usually feel all the time, and has a slight anti-depressant effect.
>
> That's good news :) What dose are you taking? Lyrica was recently approved in the UK (and the rest of the EU) for the treatment of generalised anxiety disorder. Here is some information on the dose........
>
> Generalised Anxiety Disorder
>
> The dose range is 150 to 600 mg per day given as two or three divided doses. The need for treatment should be reassessed regularly.
>
> Pregabalin treatment can be started with a dose of 150 mg per day. Based on individual patient response and tolerability, the dosage may be increased to 300 mg per day after 1 week. Following an additional week the dosage may be increased to 450 mg per day. The maximum dosage of 600 mg per day may be achieved after an additional week.
>
> >BTW Ed, I started Rozerem at the same time. It puts me to sleep but I still wake up after 3 or 4 hours
>
> Rozerem isn't generally effective for maintaining sleep :( You may need additional medication to keep you asleep.
>
> Regards
>
> Ed
>
Posted by ed_uk on May 3, 2006, at 10:54:18
In reply to Re: Lyrica/Pregabalin-Any social anx. action at 300mg? » ed_uk, posted by jakeman on May 2, 2006, at 20:18:22
Hi J
>I'm taking 75 mg of Lyrica right now.
How long does the effect last?
Ed
Posted by jakeman on May 3, 2006, at 23:19:11
In reply to Re: Lyrica/Pregabalin-Any social anx. action at 300mg? » jakeman, posted by ed_uk on May 3, 2006, at 10:54:18
Hard to say Ed, maybe 6-10 hours. I felt a less stronger response today so I might have to up the dosage.
> Hi J
>
> >I'm taking 75 mg of Lyrica right now.
>
> How long does the effect last?
>
> Ed
Posted by ed_uk on May 4, 2006, at 14:23:06
In reply to Re: Lyrica/Pregabalin-Any social anx. action at 300mg? » ed_uk, posted by jakeman on May 3, 2006, at 23:19:11
Hi J
Most people need to take it two or three times per day.
Ed
Posted by jclint on May 4, 2006, at 14:38:34
In reply to Lyrica approved for GAD in UK - dosing guidelines, posted by ed_uk on April 25, 2006, at 15:42:07
I'm glad the UK has approved an unusual drug like this for anxiety. I didn't see it coming... I'm surprised but pleased. I might give it a go further down the line.
Well done UK approval body chaps!
Posted by jakeman on May 4, 2006, at 20:22:31
In reply to Re: Lyrica/Pregabalin-Any social anx. action at 300mg? » jakeman, posted by ed_uk on May 4, 2006, at 14:23:06
Hi Ed,
I may end up doing that. I always like to start out low and see how I feel.
Jake
> Hi J
>
> Most people need to take it two or three times per day.
>
> Ed
This is the end of the thread.
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