Lyrica - patient leaflet, side effects, dosage

Patient leaflet - Lyrica

1. What Lyrica is and what it is used for

Lyrica belongs to a group of medicines used to treat epilepsy, neuropathic pain and Generalised Anxiety Disorder (GAD) in adults.

Peripheral and central neuropathic pain: Lyrica is used to treat long lasting pain caused by damage to the nerves. A variety of diseases can cause peripheral neuropathic pain, such as diabetes or shingles. Pain sensations may be described as hot, burning, throbbing, shooting, stabbing, sharp, cramping, aching, tingling, numbness, pins and needles. Peripheral and central neuropathic pain may also be associated with mood changes, sleep disturbance, fatigue (tiredness), and can have an impact on physical and social functioning and overall quality of life.

Epilepsy: Lyrica is used to treat a certain form of epilepsy (partial seizures with or without secondary generalisation) in adults. Your doctor will prescribe Lyrica for you to help treat your epilepsy when your current treatment is not controlling your condition. You should take Lyrica in addition to your current treatment. Lyrica is not intended to be used alone, but should always be used in combination with other anti-epileptic treatment.

Generalised Anxiety Disorder: Lyrica is used to treat Generalised Anxiety Disorder (GAD). The symptoms of GAD are prolonged excessive anxiety and worry that are difficult to control. GAD can also cause restlessness or feeling keyed up or on edge, being easily fatigued (tired), having difficulty concentrating or mind going blank, feeling irritable, having muscle tension or sleep disturbance. This is different to the stresses and strains of everyday life.

What you need to know before you take Lyrica

Do not take Lyrica

If you are allergic to pregabalin or any of the other ingredients of this medicine (listed in section 6).

Warnings and Precautions

Talk to your doctor or pharmacist before taking Lyrica.

Some patients taking Lyrica have reported symptoms suggesting an allergic reaction. These symptoms include swelling of the face, lips, tongue, and throat, as well as diffuse skin rash. Should you experience any of these reactions, you should contact your physician immediately.
Lyrica has been associated with dizziness and somnolence, which could increase the occurrence of accidental injury (fall) in elderly patients. Therefore, you should be careful until you are used to any effect the medicine might have.
Lyrica may cause blurring or loss of vision, or other changes in eyesight, many of which are temporary. You should immediately tell your doctor if you experience any changes in your vision.
Some patients with diabetes who gain weight while taking pregabalin may need an alteration in their diabetic medicines.
Certain side effects may be more common, such as sleepiness, because patients with spinal cord injury may be taking other medicines to treat, for example, pain or spasticity, that have similar side effects to Pregabalin and the severity of these effects may be increased when taken together.
There have been reports of heart failure in some patients when taking Lyrica; these patients were mostly elderly with cardiovascular conditions. Before taking this medicine you should tell your doctor if you have a history of heart disease.
There have been reports of kidney failure in some patients when taking Lyrica. If while taking Lyrica you notice decreased urination, you should tell your doctor as stopping the medicine may improve this.
A small number of people being treated with anti-epileptics such as Lyrica have had thoughts of harming or killing themselves. If at any time you have these thoughts, immediately contact your doctor.
When Lyrica is taken with other medicines that may cause constipation (such as some types of pain medicines) it is possible that gastrointestinal problems may occur (e.g. constipation, blocked or paralysed bowel). Tell your doctor if you experience constipation, especially if you are prone to this problem.
Before taking this medicine you should tell your doctor if you have a history of alcoholism or any drug abuse or dependence. Do not take more medicine than prescribed.
There have been reports of convulsions when taking Lyrica or shortly after stopping Lyrica. If you experience a convulsion, contact your doctor immediately.
There have been reports of reduction in brain function (encephalopathy) in some patients taking Lyrica when they have other conditions. Tell your doctor if you have a history of any serious medical conditions, including liver or kidney disease.
There have been reports of breathing difficulties. If you have nervous system disorders, respiratory disorders, renal impairment, or you are older than 65, your doctor may prescribe you a different dosing regimen. Contact your doctor if you experience trouble breathing or shallow breaths.

Children and adolescents

The safety and efficacy in children and adolescents (under 18 years of age) has not been established and therefore, pregabalin should not be used in this age group.

Other medicines and Lyrica

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Lyrica and certain other medicines may influence each other (interaction). When taken with certain other medicines which have sedative effects (including opioids), Lyrica may potentiate these effects, and could lead to respiratory failure, coma and death. The degree of dizziness, sleepiness and decreased concentration may be increased if Lyrica is taken together with medicines containing:

Oxycodone – (used as a pain-killer)

Lorazepam – (used for treating anxiety)

Alcohol

Lyrica may be taken with oral contraceptives.

Lyrica with food, drink and alcohol

Lyrica capsules may be taken with or without food.

It is advised not to drink alcohol while taking Lyrica.

Pregnancy and breast-feeding

Lyrica should not be taken during pregnancy or when breast-feeding, unless you are told otherwise by your doctor. Pregabalin use during the first 3 months of pregnancy may cause birth defects in the unborn child that require medical treatment. In a study reviewing data from women in Nordic countries who took pregabalin in the first 3 months of pregnancy, 6 babies in every 100 had such birth defects. This compares to 4 babies in every 100 born to women not treated with pregabalin in the study. Abnormalities of the face (orofacial clefts), the eyes, the nervous system (including the brain), kidneys and genitals have been reported.

Effective contraception must be used by women of childbearing potential. If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

Lyrica may produce dizziness, sleepiness and decreased concentration. You should not drive, operate complex machinery or engage in other potentially hazardous activities until you know whether this medicine affects your ability to perform these activities.

Lyrica contains lactose monohydrate

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

Lyrica contains sodium

This medicine contains less than 1 mmol sodium (23 mg) per hard capsule, that is to say essentially ‘sodium-free’.

3. How to take Lyrica

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

Your doctor will determine what dose is appropriate for you.

Lyrica is for oral use only.

Peripheral and central neuropathic pain, epilepsy or Generalised Anxiety Disorder:

Take the number of capsules as instructed by your doctor.
The dose, which has been adjusted for you and your condition, will generally be between 150 mg and 600 mg each day.
Your doctor will tell you to take Lyrica either twice or three times a day. For twice a day take Lyrica once in the morning and once in the evening, at about the same time each day. For three times a day take Lyrica once in the morning, once in the afternoon and once in the evening, at about the same time each day.

If you have the impression that the effect of Lyrica is too strong or too weak, talk to your doctor or pharmacist.

If you are an elderly patient (over 65 years of age), you should take Lyrica normally except if you have problems with your kidneys.

Your doctor may prescribe a different dosing schedule and/or dose if you have problems with your kidneys.

Swallow the capsule whole with water.

Continue taking Lyrica until your doctor tells you to stop.

If you take more Lyrica than you should

Call your doctor or go to the nearest hospital emergency unit immediately. Take your box or bottle of Lyrica capsules with you. You may feel sleepy, confused, agitated, or restless as a result of taking more Lyrica than you should. Fits have also been reported.

If you forget to take Lyrica

It is important to take your Lyrica capsules regularly at the same time each day. If you forget to take a dose, take it as soon as you remember unless it is time for your next dose. In that case, just carry on with the next dose as normal. Do not take a double dose to make up for a forgotten dose.

If you stop taking Lyrica

Do not stop taking Lyrica unless your doctor tells you to. If your treatment is stopped it should be done gradually over a minimum of 1 week.

After stopping long and short-term Lyrica treatment, you need to know that you may experience certain side effects. These include, trouble sleeping, headache, nausea, feeling anxious, diarrhoea, flu like symptoms, convulsions, nervousness, depression, pain, sweating, and dizziness. These symptoms may occur more commonly or severely if you have been taking Lyrica for a longer period of time.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Very common: may affect more than 1 in 10 people

Dizziness, drowsiness, headache.

Common: may affect up to 1 in 10 people

Increased appetite.
Feeling of elation, confusion, disorientation, decrease in sexual interest, irritability.
Disturbance in attention, clumsiness, memory impairment, loss of memory, tremor, difficulty with speaking, tingling feeling, numbness, sedation, lethargy, insomnia, fatigue, feeling abnormal.
Blurred vision, double vision.
Vertigo, problems with balance, fall.
Dry mouth, constipation, vomiting, flatulence, diarrhoea, nausea, swollen abdomen.
Difficulties with erection.
Swelling of the body including extremities.
Feeling drunk, abnormal style of walking.
Weight gain.
Muscle cramp, joint pain, back pain, pain in limb.
Sore throat.

Uncommon: may affect up to 1 in 100 people

Loss of appetite, weight loss, low blood sugar, high blood sugar.

Change in perception of self, restlessness, depression, agitation, mood swings, difficulty finding words, hallucinations, abnormal dreams, panic attack, apathy, aggression, elevated mood, mental impairment, difficulty with thinking, increase in sexual interest, problems with sexual functioning including inability to achieve a sexual climax, delayed ejaculation.

Changes in eyesight, unusual eye movement, changes in vision including tunnel vision, flashes of light, jerky movements, reduced reflexes, increased activity, dizziness on standing, sensitive skin, loss of taste, burning sensation, tremor on movement, decreased consciousness, loss of consciousness, fainting, increased sensitivity to noise, feeling unwell.

Dry eyes, eye swelling, eye pain, weak eyes, watery eyes, eye irritation.

Heart rhythm disturbances, increased heart rate, low blood pressure, high blood pressure, changes in heart beat, heart failure.

Flushing, hot flushes.

Difficulty breathing, dry nose, nasal congestion.

Increased saliva production, heartburn, numb around mouth.

Sweating, rash, chills, fever.

Muscle twitching, joint swelling, muscle stiffness, pain including muscle pain, neck pain.

Breast pain.

Difficulty with or painful urination, incontinence.

Weakness, thirst, chest tightness.

Changes in blood and liver test results (blood creatinine phosphokinase increased, alanine amino transferase increased, aspartate aminotransferase increased, platelet count decreased, neutropaenia, increase in blood creatinine, decrease in blood potassium).

Hypersensitivity, swollen face, itchiness, hives, runny nose, nose bleed, cough, snoring.

Painful menstrual periods.

Coldness of hands and feet.

Rare: may affect up to 1 in 1,000 people

Abnormal sense of smell, swinging vision, altered perception of depth, visual brightness, vision loss.
Dilated pupils, cross eyes.
Cold sweat, tightness of the throat, swollen tongue.
Inflammation of the pancreas.
Difficulty in swallowing.
Slow or reduced movement of the body.
Difficulty with writing properly.
Increased fluid in the abdomen.
Fluid in the lungs.
Convulsions.
Changes in the recording of electrical changes (ECG) in the heart which correspond to heart

rhythm disturbances.

Muscle damage.
Breast discharge, abnormal breast growth, breast growth in males.
Interrupted menstrual periods.
Kidney failure, reduced urine volume, urinary retention.
Decrease in white blood cell count.
Inappropriate behaviour.
Allergic reactions (which may include difficulty breathing, inflammation of the eyes (keratitis) and a serious skin reaction characterized by rash, blisters, peeling skin and pain).
Jaundice (yellowing of the skin and eyes).
Parkinsonism, that is symptoms resembling Parkinson’s disease; such as tremor, bradykinesia (decreased ability to move), and rigidity (muscle stiffness).

Very rare: may affect up to 1 in 10,000 people

Liver failure.
Hepatitis (inflammation of the liver).

5. How to store Lyrica

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton or bottle. The expiry date refers to the last day of that month.

This medicine does not require any special storage conditions.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

Contents of the pack and other information

What Lyrica contains

The active substance is pregabalin. Each hard capsule contains either 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg or 300 mg pregabalin.

The other ingredients are: lactose monohydrate, maize starch, talc, gelatine, titanium dioxide (E171), sodium laurilsulphate, anhydrous colloidal silica, black ink, (which contains shellac, black iron oxide (E172), propylene glycol, potassium hydroxide) and water.

The 75 mg, 100 mg, 200 mg, 225 mg and 300 mg capsules also contain red iron oxide (E172).

What Lyrica looks like and contents of the pack

25 mg capsules

White hard capsules, with “Pfizer” marked on the cap and “PGN 25” on the body.

50 mg capsules

White hard capsules, with “Pfizer” marked on the cap and “PGN 50”on the body. The capsule body is marked with a black band.

75 mg capsules

White and orange hard capsules with “Pfizer” marked on the cap and “PGN 75” on the body.

100 mg capsules

Orange hard capsules, with “Pfizer” marked on the cap and “PGN 100” on the body.

150 mg capsules

White hard capsules, with “Pfizer” marked on the cap and “PGN 150” on the body.

200 mg capsules

Light orange hard capsules, with “Pfizer” marked on the cap and “PGN 200” on the body.

225 mg capsules

White and light orange hard capsules, with “Pfizer” marked on the cap and “PGN 225” on the body.

300 mg capsules

White and orange hard capsules, with “Pfizer” marked on the cap and “PGN 300” on the body.

Lyrica is available in eight pack sizes made of PVC with an aluminium foil backing: a 14 capsules pack containing 1 blister strip, a 21 capsules pack containing 1 blister strip, a 56 capsules pack containing 4 blister strips, a 70 capsules pack containing 5 blister strips, a 84 capsules pack containing 4 blister strips, a 100 capsules pack containing 10 blister strips, a 112 capsules pack containing 8 blister strips and 100 × 1 capsules as perforated unit dose blisters.

In addition, Lyrica is available in an HDPE bottle containing 200 capsules for the 25 mg, 75 mg, 150 mg and 300 mg strengths.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder:

Upjohn EESV, Rivium Westlaan 142, 2909 LD Capelle aan den IJssel, Netherlands.

Manufacturer:

Pfizer Manufacturing Deutschland GmbH, Betriebsstatte Freiburg, Mooswaldallee 1, 79090 Freiburg, Germany.

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

Belgie/Belgique/Belgien Lietuva

Pfizer S.A. / N.V. Pfizer Luxembourg SARL filialas Lietuvoje

Tel/Tel: +32 (0)2 554 62 11 Tel. +3705 2514000

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Ten.: +359 2 970 4333

Česká republika

Pfizer spol s.r.o.

Tel: D+42O-283-OO4–111

Danmark

Viatris ApS

Tlf: +45 28 11 69 32

Deutschland

Pfizer OFG Germany GmbH

Tel: +49 (0)800 5500634

Eesti

Pfizer Luxembourg SARL Eesti filiaal

Tel: +372 666 7500

ELLáóa

UPJOHN HELLAS EnE

T|L: +30 2100 1OO OOI

España

Viatris Pharmaceuticals, S.L.

Tel: +34 900 102 712

France

Viatris Santé

Tél: +33 (0)4 37 25 75 00

Hrvatska

Mylan Hrvatska d.o.o.

Tel: + 385 1 23 50 599

Ireland

Pfizer Healthcare Ireland

Tel: +1800 633 363 (toll free)

Tel: +44 (0)1304 616161

Ísland

Icepharma hf.

Sími: +354 540 8000

Italia

Viatris Pharma S.r.l.

Tel: +39 02 612 46921

Kúnpog

GPA Pharmaceuticals Ltd

Tql: +357 228631OO

Luxembourg/Luxemburg

Pfizer S.A.

Tél/Tel: +32 (0)2 554 62 11

Magyarország

Pfizer Kft.

Tel. + 36 1 488 37 00

Malta

Vivian Corporation Ltd.

Tel: +356 21344610

Nederland

Pfizer bv

Tel: +31 (0)10 406 4301

Norge

Pfizer AS

Tlf: +47 67 52 61 00

Österreich

Pfizer Corporation Austria Ges.m.b.H.

Tel: +43 (0)1 521 15–0

Polska

Pfizer Polska Sp. z o.o.

Tel.: +48 22 335 61 00

Portugal

Laboratórios Pfizer, Lda.

Tel: +351 21 423 5500

România

Pfizer România S.R.L.

Tel: +40 (0)21 207 28 00

Slovenija

Pfizer Luxembourg SARL,

Pfizer, podružnica za svetovanje s področja farmacevtske dejavnosti, Ljubljana

Tel: +386 (0)1 52 11 400

Slovenská republika

Pfizer Luxembourg SARL, organizačná zložka

Tel: +421–2–3355 55OO

Suomi/Finland

Viatris Oy

Puh./Tel: +358 20 720 9555

Sverige

Viatris AB

Tel: +46 (0)8 630 19 00

Latvija

Pfizer Luxembourg SARL filiale Latvija

Tel: +371 670 35 775

United Kingdom (Northern Ireland)

Pfizer Limited