FDA Label for Pregabalin
View Indications, Usage & Precautions
Pregabalin Product Label
The following document was submitted to the FDA by the labeler of this product Advanced Rx Pharmacy Of Tennessee, Llc. The document includes published materials associated whith this product with the essential scientific information about this product as well as other prescribing information. Product labels may durg indications and usage, generic names, contraindications, active ingredients, strength dosage, routes of administration, appearance, warnings, inactive ingredients, etc.
Medication Guide Section
MEDICATION GUIDE
Pregabalin (pree gabʹ a lin) Capsules, CV
Read this Medication Guide before you start taking pregabalin capsules and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment. If you have any questions about pregabalin capsules, ask your healthcare provider or pharmacist.
What is the most important information I should know about pregabalin capsules?
Pregabalin capsules may cause serious side effects including:
serious, even life-threatening, allergic reactions
swelling of your hands, legs and feet
suicidal thoughts or actions
dizziness and sleepiness
serious breathing problems
These serious side effects are described below:
Serious, even life-threatening, allergic reactions.
Stop taking pregabalin capsules and call your healthcare provider right away if you have any of these signs of a serious allergic reaction:
swelling of your face, mouth, lips, gums, tongue, throat or neck
trouble breathing
rash, hives (raised bumps) or blisters
Like other antiepileptic drugs, pregabalin capsules may cause suicidal thoughts or actions in a very small number of people, about 1 in 500. Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:
thoughts about suicide or dying
trouble sleeping (insomnia)
attempts to commit suicide
new or worse irritability
new or worse depression
acting aggressive, being angry, or violent
new or worse anxiety
acting on dangerous impulses
feeling agitated or restless
an extreme increase in activity and talking (mania)
panic attacks
other unusual changes in behavior or mood
If you have suicidal thoughts or actions, do not stop pregabalin capsules without first talking to a healthcare provider.
Stopping pregabalin capsules suddenly can cause serious problems.
Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.
How can I watch for early symptoms of suicidal thoughts and actions?
Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings.
Keep all follow-up visits with your healthcare provider as scheduled.
Call your healthcare provider between visits as needed, especially if you are worried about symptoms.
Serious breathing problems can occur when pregabalin capsules is taken with other medicines that can cause severe sleepiness or decreased awareness, or when it is taken by someone who already has breathing problems. Watch for increased sleepiness or decreased breathing when starting pregabalin capsules or when the dose is increased. Get help right away if breathing problems occur.
Swelling of your hands, legs and feet. This swelling can be a serious problem for people with heart problems.
Dizziness and sleepiness. Do not drive a car, work with machines, or do other dangerous activities until you know how pregabalin capsule affects you. Ask your healthcare provider about when it will be okay to do these activities.
What are pregabalin capsules?
Pregabalin capsules are a prescription medicine used in adults, 18 years of age and older to treat:
pain from damaged nerves (neuropathic pain) that happens with diabetes
pain from damaged nerves (neuropathic pain) that follows healing of shingles
fibromyalgia (pain all over your body)
pain from damaged nerves (neuropathic pain) that follows spinal cord injury
It is not known if pregabalin capsules are safe and effective in people under 18 years of age for the treatment of fibromyalgia and neuropathic pain with diabetes, shingles, or spinal cord injury.
Pregabalin capsules are a prescription medicine used in people 17 years of age and older to treat:
partial-onset seizures when taken together with other seizure medicines.
For the treatment of partial-onset seizures when taken together with other seizure medicines, it is not known if pregabalin capsules are safe and effective in children under 1 month of age.
Who should not take pregabalin capsules?
Do not take pregabalin capsules if you are allergic to pregabalin or any of the ingredients in pregabalin capsules.
See “What is the most important information I should know about pregabalin capsules?” for the signs of an allergic reaction. See the end of this Medication Guide for a complete list of ingredients in pregabalin capsules.
What should I tell my healthcare provider before taking pregabalin capsules?
Before taking pregabalin capsules, tell your healthcare provider about all your medical conditions, including if you:
have or have had depression, mood problems or suicidal thoughts or behavior.
have breathing problems.
have kidney problems or get kidney dialysis.
have heart problems including heart failure.
have a bleeding problem or a low blood platelet count.
have abused prescription medicines, street drugs, or alcohol in the past.
have ever had swelling of your face, mouth, tongue, lips, gums, neck, or throat (angioedema).
plan to father a child. Animal studies have shown that pregabalin, the active ingredient in pregabalin capsules, made male animals less fertile and caused sperm to change. Also, in animal studies, birth defects were seen in the offspring (babies) of male animals treated with pregabalin. It is not known if these problems can happen in people who take pregabalin capsules.
are pregnant or plan to become pregnant. Pregabalin capsules may harm your unborn baby. You and your healthcare provider will decide if you should take pregabalin capsules while you are pregnant.
If you become pregnant while taking pregabalin capsules, talk to your healthcare provider about registering with the North American Antiepileptic Drug Pregnancy Registry. You can enroll in this registry by calling 1-888-233-2334. The purpose of this registry is to collect information about the safety of antiepileptic drugs during pregnancy. Information about the registry can also be found at the website, http://www.aedpregnancyregistry.org/.
are breastfeeding or plan to breastfeed. Pregabalin passes into your breast milk. It is not known if pregabalin capsules can harm your baby. Talk to your healthcare provider about the best way to feed your baby if you take pregabalin capsules. Breastfeeding is not recommended while taking pregabalin capsules.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins or herbal supplements. Pregabalin capsules and other medicines may affect each other causing side effects. Especially tell your healthcare provider if you take:
angiotensin converting enzyme (ACE) inhibitors, which are used to treat many conditions, including high blood pressure. You may have a higher chance for swelling and hives if these medicines are taken with pregabalin capsules.
Avandia (rosiglitazone) or Actos (pioglitazone) for diabetes. You may have a higher chance of weight gain or swelling of your hands or feet if these medicines are taken with pregabalin capsules.
any opioid pain medicine (such as oxycodone), or medicines for anxiety (such as lorazepam) or insomnia (such as zolpidem). You may have a higher chance for dizziness, sleepiness or serious breathing problems if these medicines are taken with pregabalin capsules.
any medicines that make you sleepy.
Know the medicines you take. Keep a list of them with you to show your healthcare provider and pharmacist each time you get a new medicine. Do not start a new medicine without talking with your healthcare provider.
How should I take pregabalin capsules?
Take pregabalin capsules exactly as prescribed. Your healthcare provider will tell you how much pregabalin capsules to take and when to take it.
Pregabalin capsules may be taken with or without food.
Your healthcare provider may change your dose. Do not change your dose without talking to your healthcare provider.
Do not stop taking pregabalin capsules without talking to your healthcare provider. If you stop taking pregabalin capsules suddenly you may have headaches, nausea, diarrhea, trouble sleeping, increased sweating, or you may feel anxious. If you have epilepsy and you stop taking pregabalin capsules suddenly, you may have seizures more often. Talk with your healthcare provider about how to stop pregabalin capsules slowly.
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, just skip the missed dose. Take the next dose at your regular time. Do not take 2 doses at the same time.
If you take too much pregabalin capsules, call your healthcare provider or poison control center, or go to the nearest emergency room right away.
What should I avoid while taking pregabalin capsules?
Do not drive a car, work with machines, or do other dangerous activities until you know how pregabalin capsules affects you.
Do not drink alcohol while taking pregabalin capsules. Pregabalin capsules and alcohol can affect each other and increase side effects such as sleepiness and dizziness.
What are the possible side effects of pregabalin capsules?
Pregabalin capsules may cause serious side effects, including:
See "What is the most important information I should know about pregabalin capsules?"
Muscle problems, muscle pain, soreness, or weakness. If you have these symptoms, especially if you feel sick and have a fever, tell your healthcare provider right away.
Problems with your eyesight, including blurry vision. Call your healthcare provider if you have any changes in your eyesight.
Weight gain. If you have diabetes, weight gain may affect the management of your diabetes. Weight gain can also be a serious problem for people with heart problems.
Feeling "high".
The most common side effects of pregabalin capsules in adults are:
dizziness
weight gain
trouble concentrating
blurry vision
sleepiness
swelling of hands and feet
dry mouth
Pregabalin capsules caused skin sores in animal studies. Skin sores did not happen in studies in people. If you have diabetes, you should pay attention to your skin while taking pregabalin capsules and tell your healthcare provider about any sores or skin problems.
Tell your healthcare provider about any side effect that bothers you or that does not go away.
These are not all the possible side effects of pregabalin capsules. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
How should I store pregabalin capsules?
Store pregabalin capsules at room temperature, 20° to 25°C (68° to 77°F); excursions permitted between 15° to 30°C (59° to 86°F) in its original package.
Safely throw away any pregabalin capsules that is out of date or no longer needed.
Keep pregabalin capsules and all medicines out of the reach of children.
General information about the safe and effective use of pregabalin capsules
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use pregabalin capsules for a condition for which it was not prescribed. Do not give pregabalin capsules to other people, even if they have the same symptoms you have. It may harm them. You can ask your healthcare provider or pharmacist for information about pregabalin capsules that is written for health professionals.
What are the ingredients in pregabalin capsules?
Active ingredient: pregabalin
Inactive ingredients: pregelatinized starch and talc.
The capsule shells contain gelatin and titanium dioxide. In addition, the orange capsule shells contain red iron oxide and white capsule shells contain sodium lauryl sulfate.
Each capsule shell is imprinted with black pharmaceutical ink which contains: butyl alcohol, dehydrated alcohol, ferrosoferric oxide, isopropyl alcohol, propylene glycol, potassium hydroxide, purified water, strong ammonia solution and shellac.
Pediatric use information is approved for Pfizer’s LYRICA (pregabalin) Capsules. However, due to Pfizer’s marketing exclusivity rights, this drug product is not labeled with that pediatric information.
For more information, go to www.amneal.com or call 1-877-835-5472.
This Medication Guide has been approved by the U.S. Food and Drug Administration.
Manufactured by:
Amneal Pharmaceuticals Pvt. Ltd.
Oral Solid Dosage Unit
Ahmedabad 382213, INDIA
Distributed by:
Amneal Pharmaceuticals LLC
Bridgewater, NJ 08807
Rev. 06-2020-01
Dosage And Administration Section
2 DOSAGE AND ADMINISTRATION
2.1 Important Administration Instructions
Pregabalin capsules are given orally with or without food.
When discontinuing pregabalin capsules, taper gradually over a minimum of 1 week [see Warnings and Precautions (5.6)].
Because pregabalin is eliminated primarily by renal excretion, adjust the dose in adult patients with reduced renal function [see Dosage and Administration (2.7)].
2.2 Neuropathic Pain Associated with Diabetic Peripheral Neuropathy in Adults
The maximum recommended dose of pregabalin capsule is 100 mg three times a day (300 mg/day) in patients with creatinine clearance of at least 60 mL/min. Begin dosing at 50 mg three times a day (150 mg/day). The dose may be increased to 300 mg/day within 1 week based on efficacy and tolerability.
Although pregabalin capsule was also studied at 600 mg/day, there is no evidence that this dose confers additional significant benefit and this dose was less well tolerated. In view of the dose-dependent adverse reactions, treatment with doses above 300 mg/day is not recommended [see Adverse Reactions (6.1)].
2.3 Postherpetic Neuralgia in Adults
The recommended dose of pregabalin capsule is 75 mg to 150 mg two times a day, or 50 mg to 100 mg three times a day (150 to 300 mg/day) in patients with creatinine clearance of at least 60 mL/min. Begin dosing at 75 mg two times a day, or 50 mg three times a day (150 mg/day). The dose may be increased to 300 mg/day within 1 week based on efficacy and tolerability.
Patients who do not experience sufficient pain relief following 2 to 4 weeks of treatment with 300 mg/day, and who are able to tolerate pregabalin capsules, may be treated with up to 300 mg two times a day, or 200 mg three times a day (600 mg/day). In view of the dose-dependent adverse reactions and the higher rate of treatment discontinuation due to adverse reactions, reserve dosing above 300 mg/day for those patients who have on-going pain and are tolerating 300 mg daily [see Adverse Reactions (6.1)].
2.4 Adjunctive Therapy for Partial-Onset Seizures in Patients 17 Years of Age and Older
The recommended dosages for adult patients 17 years of age and older is included in Table 1. Administer the total daily dosage orally in two or three divided doses as indicated in Table 1. Based on clinical response and tolerability, dosage may be increased, approximately weekly.
Table 1. Recommended Dosage for Adult Patients 17 Years and Older
Age and Body Weight
Recommended Initial Dosage
Recommended Maximum Dosage
Frequency of Administration
Adults (17 years and older)
150 mg/day
600 mg/day
2 or 3 divided doses
Both the efficacy and adverse event profiles of pregabalin capsules have been shown to be dose-related.
The effect of dose escalation rate on the tolerability of pregabalin capsules has not been formally studied.
The efficacy of adjunctive pregabalin capsules in patients taking gabapentin has not been evaluated in controlled trials. Consequently, dosing recommendations for the use of pregabalin capsules with gabapentin cannot be offered.
Pediatric use information is approved for Pfizer’s LYRICA (pregabalin) Capsules. However, due to Pfizer’s marketing exclusivity rights, this drug product is not labeled with that pediatric information.
2.5 Management of Fibromyalgia in Adults
The recommended dose of pregabalin capsules for fibromyalgia is 300 to 450 mg/day. Begin dosing at 75 mg two times a day (150 mg/day). The dose may be increased to 150 mg two times a day (300 mg/day) within 1 week based on efficacy and tolerability. Patients who do not experience sufficient benefit with 300 mg/day may be further increased to 225 mg two times a day (450 mg/day). Although pregabalin capsule was also studied at 600 mg/day, there is no evidence that this dose confers additional benefit and this dose was less well tolerated. In view of the dose-dependent adverse reactions, treatment with doses above 450 mg/day is not recommended [see Adverse Reactions (6.1)].
2.6 Neuropathic Pain Associated with Spinal Cord Injury in Adults
The recommended dose range of pregabalin capsules for the treatment of neuropathic pain associated with spinal cord injury is 150 to 600 mg/day. The recommended starting dose is 75 mg two times a day (150 mg/day). The dose may be increased to 150 mg two times a day (300 mg/day) within 1 week based on efficacy and tolerability. Patients who do not experience sufficient pain relief after 2 to 3 weeks of treatment with 150 mg two times a day and who tolerate pregabalin capsules may be treated with up to 300 mg two times a day [see Clinical Studies (14.5)].
2.7 Dosing for Adult Patients with Renal Impairment
In view of dose-dependent adverse reactions and since pregabalin is eliminated primarily by renal excretion, adjust the dose in adult patients with reduced renal function. The use of pregabalin capsules in pediatric patients with compromised renal function has not been studied.
Base the dose adjustment in patients with renal impairment on creatinine clearance (CLcr), as indicated in Table 2. To use this dosing table, an estimate of the patient's CLcr in mL/min is needed. CLcr in mL/min may be estimated from serum creatinine (mg/dL) determination using the Cockcroft and Gault equation:
[10]
Next, refer to the Dosage and Administration section to determine the recommended total daily dose based on indication, for a patient with normal renal function (CLcr greater than or equal to 60 mL/min). Then refer to Table 2 to determine the corresponding renal adjusted dose.
(For example: A patient initiating pregabalin therapy for postherpetic neuralgia with normal renal function (CLcr greater than or equal to 60 mL/min), receives a total daily dose of 150 mg/day pregabalin. Therefore, a renal impaired patient with a CLcr of 50 mL/min would receive a total daily dose of 75 mg/day pregabalin administered in two or three divided doses.)
For patients undergoing hemodialysis, adjust the pregabalin daily dose based on renal function. In addition to the daily dose adjustment, administer a supplemental dose immediately following every 4-hour hemodialysis treatment (see Table 2).
Table 2. Pregabalin Dosage Adjustment Based on Renal Function
Creatinine Clearance (CLcr)
(mL/min)
Total Pregabalin Daily Dose
(mg/day)*
Dose Regimen
Greater than or equal to 60
150
300
450
600
BID or TID
30 to 60
75
150
225
300
BID or TID
15 to 30
25 to 50
75
100 to 150
150
QD or BID
Less than 15
25
25 to 50
50 to 75
75
QD
Supplementary dosage following hemodialysis (mg)†
Patients on the 25 mg QD regimen: take one supplemental dose of 25 mg or 50 mg
Patients on the 25 to 50 mg QD regimen: take one supplemental dose of 50 mg or 75 mg
Patients on the 50 to 75 mg QD regimen: take one supplemental dose of 75 mg or 100 mg
Patients on the 75 mg QD regimen: take one supplemental dose of 100 mg or 150 mg
TID= Three divided doses; BID = Two divided doses; QD = Single daily dose.
*Total daily dose (mg/day) should be divided as indicated by dose regimen to provide mg/dose.
†Supplementary dose is a single additional dose.
Indications And Usage Section
1 INDICATIONS AND USAGE
Pregabalin capsules are indicated for:
Management of neuropathic pain associated with diabetic peripheral neuropathy
Management of postherpetic neuralgia
Adjunctive therapy for the treatment of partial-onset seizures in patients 17 years of age and older
Management of fibromyalgia
Management of neuropathic pain associated with spinal cord injury
Pediatric use information is approved for Pfizer’s LYRICA (pregabalin) Capsules. However, due to Pfizer’s marketing exclusivity rights, this drug product is not labeled with that pediatric information.
* Please review the disclaimer below.