Course Summary

Pregabalin, a gamma-aminobutyric acid (GABA) analogue, is widely used for managing neuropathic pain, fibromyalgia, partial-onset seizures, and various off-label conditions such as generalized anxiety disorder and trigeminal neuralgia. Pregabalin effectively alleviates physical and emotional symptoms by targeting the alpha-2-delta subunit of voltage-gated calcium channels. Health clinicians equipped with a comprehensive understanding of pregabalin’s pharmacology, therapeutic uses, dosing, safety profile, and monitoring strategies are better able to improve clinical outcomes and ensure safe, effective treatment. Pregabalin toxicity, including risk factors associated with a co-occurring psychiatric or substance use diagnosis, is discussed and highlighted in case studies.

Course Format

Homestudy

Course Syllabus

• Introduction
• Pharmacological Profile
  • Mechanism of Action: Impact on Neuronal Calcium Currents
  • Indications, Dosing, and Administration
  • Dosing: Label and Off-label Uses
  • Renal Impairment Dosing
  • Hepatic Impairment Dosing
  • Geriatric Dosing
  • Tapering and Discontinuation to Minimize Withdrawal
• Clinical Applications: Primary Indications with Efficacy Data
  • Neuropathic Pain
  • Fibromyalgia
  • Partial-Onset Seizures (Adjunctive Therapy)
  • Off-Label Indications with Efficacy Data and Guidelines
• Contraindications and Precautions
  • Adverse Effects
  • Pregnancy and Breastfeeding
  • Drug-Drug Interactions
  • Monitoring: Baseline and Continuous Assessments
• Pregabalin Toxicity: Diagnosis and Management
  • Differential Diagnosis
  • Therapeutic Management and Monitoring
  • Role of the Interprofessional Health Team
• Clinical Pearls
• Case Study 1: Pregabalin-Induced Stuttering and Blepharospasm
  • Differential Diagnosis and Clinical Management
• Case Study 2: Delirium Associated with Pregabalin Withdrawal
  • Differential Diagnosis and Clinical Management
• Case Study 3: Intentional Overdose and Pregabalin Toxicity
  • Differential Diagnosis and Clinical Management Summary

Authors

Richard Daniels, PharmD, BCPS

Richard “Cole” Daniels earned his Doctor of Pharmacy(PharmD) from the Skaggs School of Pharmacy at the University of Montana in 2018. Throughout pharmacy school he completed a 3-year internship at Community Medical Center in Missoula, Montana in which he gained valuable experience in an acute care setting. Cole currently serves as a psychiatric clinical staff pharmacist at the Montana State Hospital. He has over 11 years of pharmacy experience having worked in several settings including retail, acute care, and inpatient psychiatric care. Cole has a diverse set of interests. However, acute care medicine, infectious disease, pain management, and asthma/COPD are a primary focus of his at the Montana State Hospital. He obtained board certification as a certified pharmacotherapy specialist in the Spring of 2022.

Elisabeth Gordon, BScPharm, RPh

Elisabeth Gordon earned her BSc(Pharm) from the University of British Columbia in 2004. After graduation, she worked in community retail pharmacies on Vancouver Island, before returning to her rural hometown of Salmon Arm. In 2016 and 2017, Elisabeth trained with Pallium Canada and Victoria Hospice to enhance her knowledge of end-of-life-care and palliative services. She is a volunteer medical supervisor for T1DOutreach, a peer support platform for adults living with type 1 diabetes, and a member of a Canadian peer support group for adults living with Birdshot Uveitis. Elisabeth enjoys working in a small, fast-paced rural pharmacy where she brings compassion and empathy to her everyday practice.