Neurica Drug Interactions

Drugs affecting hepatic microsomal enzymes: Based on results of in vitro studies, pregabalin does not appear to inhibit cytochrome P-450 (CYP) isoenzymes 1A2, 2A6, 2C9, 2C19, 2D6, 2E1, and 3A4 or induce CYP1A2 or CYP3A4.
Increased metabolism of concomitantly administered CYP1A2 substrates (e.g., caffeine, theophylline) or CYP3A4 substrates (e.g., midazolam, testosterone) is not anticipated.
Since pregabalin undergoes negligible metabolism in humans, pharmacokinetics of the drug are unlikely to be affected by other agents through metabolic interactions.
Drugs that cause constipation: Concomitant use of pregabalin and drugs that can cause constipation (e.g., opiate analgesics) has been associated with adverse events related to reduced lower gastrointestinal (GI) tract function (e.g., intestinal obstruction, paralytic ileus, constipation).
Protein bound Drugs: Because pregabalin does not bind to plasma proteins, pharmacokinetic interactions with drugs that are highly protein bound are unlikely.
Alcohol: Although a pharmacokinetic interaction has not been observed with pregabalin and alcohol, additive effects on cognitive and gross motor functioning have occurred; however, concomitant use of pregabalin and alcohol did not result in any clinically important effects on respiration. Use of alcohol should be avoided in patients receiving pregabalin.
Angiotensin converting enzyme inhibitors: Potential pharmacologic interaction with ACE inhibitors (e.g., increased risk of developing angioedema).
Anticonvulsants: Pharmacokinetic interactions have not been observed when pregabalin was used concomitantly with phenytoin, carbamazepine, valproate, lamotrigine, phenobarbital, or topiramate.
Concomitant administration of gabapentin with pregabalin did not alter pharmacokinetics of gabapentin, although the rate, but not extent, of absorption of pregabalin was decreased slightly.
Tiagabine does not appear to affect the pharmacokinetics of pregabalin.
Antidiabetic agents: Glyburide, insulin, and metformin do not appear to affect the pharmacokinetics of pregabalin.
Concomitant use of pregabalin and thiazolidinediones may increase the risk of weight gain and peripheral edema, possibly exacerbating or causing heart failure. Caution is advised when these drugs are used concomitantly.
CNS depressants: Additive CNS and respiratory depressant effects can occur with concurrent use of pregabalin and CNS depressants, including opiates and benzodiazepines. If pregabalin is used concomitantly with other CNS depressants, pregabalin should be initiated with the lowest dosage and titrated carefully.
Erythromycin: Concomitant administration of a single dose of pregabalin (as the extended-release tablet) and erythromycin resulted in a 17% decrease in systemic exposure of pregabalin.
Furosemide: Furosemide does not appear to affect the pharmacokinetics of pregabalin.
Lorazepam: Although a pharmacokinetic interaction has not been observed, additive effects on cognitive and gross motor functioning have occurred when pregabalin was administered concomitantly with lorazepam; concomitant use of these drugs did not result in any clinically important effects on respiration.
Opiates: Additive CNS and respiratory depressant effects can occur with concurrent use of pregabalin and opiates. If pregabalin is used concomitantly with opiates, pregabalin should be initiated with the lowest dosage and titrated carefully.
In addition, events related to reduced lower GI function (e.g., intestinal obstruction, paralytic ileus, constipation) have been reported during post marketing experience in patients taking pregabalin concomitantly with drugs that have the potential to produce constipation, such as opiates.
Oxycodone: Although a pharmacokinetic interaction has not been observed, additive effects on cognitive and gross motor functioning have occurred when pregabalin was administered concomitantly with oxycodone; concomitant use of these drugs did not result in any clinically important effects on respiration.
Oral contraceptives: Concomitant administration of pregabalin and an oral contraceptive containing norethindrone and ethinyl estradiol in healthy individuals did not affect the pharmacokinetics of either component of the oral contraceptive.