Pregabalin

INTRODUCTION

Indications

Pain due to diabetic peripheral neuropathy, postherpetic neuralgia, fibromyalgia. Adjunctive therapy of partial-onset seizures in adults.

Action

Binds to calcium channels in CNS tissues which regulate neurotransmitter release. Does not bind to opioid receptors. Therapeutic Effects: Decreased neuropathic or postherpetic pain. Decreased partial-onset seizures.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, impaired attention/concentration/thinking. CV: edema. EENT: blurred vision. GI: dry mouth, abdominal pain, constipation, ↑ appetite, vomiting. Hemat: ↓ platelet count. Metab: weight gain. Misc: allergic reactions, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess pain using visual analogue scales and other appropriate pain scales when this drug is used to treat neuropathic pain or other pain syndromes (fibromyalgia, postherpetic neuralgia). Document any changes in pain to help determine the effects of drug therapy.

• If used to treat seizures, document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity.

• Monitor and report drowsiness, concentration difficulties, or other cognitive impairments. Repeated or excessive symptoms may require change in dose or medication.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician if these reactions occur.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a substantial or unexplained weight gain or increase in body fat.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), especially if gait and balance are affected by drowsiness or dizziness. Implement fall-prevention strategies, especially if balance is impaired (See Appendix E).

• If treating neuropathic pain or other pain syndromes, implement appropriate interventions (physical agents, manual techniques, therapeutic exercise) to manage pain and reduce the need for drug therapy. Help patient also explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, imagery, counseling, and so forth.

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Advise patients on prolonged antiseizure therapy not to discontinue medication without consulting their physician. Abrupt withdrawal may ...