What is Prerica?
Prerica is a medication used to treat neuropathic pain in adults. Neuropathic pain is a type of chronic pain that occurs due to damage or dysfunction in the nerves. This pain is often described as burning, shooting, stabbing, or tingling. Prerica contains the active ingredient pregabalin.
Pregabalin belongs to a class of medications called anticonvulsants, but it is also used to treat nerve pain. It works by calming down the overactive nerves that are causing pain.
Prerica is specifically indicated for neuropathic pain arising from two conditions:
- Herpes Zoster infections (shingles): Shingles is a viral infection that can cause long-lasting nerve pain even after the rash clears up. This pain is known as postherpetic neuralgia.
- Diabetes: Long-term diabetes can damage nerves throughout the body, leading to pain, numbness, and tingling, especially in the hands and feet. This is called diabetic neuropathy.
Prerica Strengths and Appearance
Prerica comes in hard capsule form and is available in a range of strengths to meet individual patient needs:
- Prerica 25 mg: White cap and white body, size 4 capsule with “PGB 25” printed in black ink.
- Prerica 50 mg: White cap and white body, size 3 capsule with “PGB 50” printed in black ink and a black band.
- Prerica 75 mg: Orange cap and white body, size 4 capsule with “PGB 75” printed in black ink.
- Prerica 100 mg: Orange cap and orange body, size 3 capsule with “PGB 100” printed in black ink.
- Prerica 150 mg: White cap and white body, size 2 capsule with “PGB 150” printed in black ink.
Prerica Dosage and Administration
The way your doctor prescribes Prerica will depend on several factors, including the severity of your pain, your response to the medication, and any other medical conditions you may have.
Typical Prerica Dosage
- Starting Dose: The usual starting dose is 75 mg twice daily (total of 150 mg per day).
- Dosage Increases: Depending on how well you respond to the medication and how well you tolerate it, your doctor may increase your dose to 150 mg twice daily (total of 300 mg per day) after 3 to 7 days.
- Maximum Dose: The maximum recommended daily dose is 300 mg.
Prerica can be taken with or without food, meaning you can fit it into your daily routine easily.
Discontinuing Prerica
It is important not to stop taking Prerica suddenly without talking to your doctor. Stopping Prerica abruptly can lead to unpleasant withdrawal symptoms. These might include:
- Insomnia
- Headache
- Nausea
- Anxiety
- Diarrhoea
- Flu-like symptoms
- Nervousness
- Depression
- Pain
- Convulsions
- Excessive sweating
- Dizziness
If you need to stop taking Prerica, your doctor will gradually reduce your dose over at least one week to minimise the risk of these withdrawal symptoms.
Pregabalin: What You Need to Know
Prerica Dosage for Specific Populations
The standard Prerica dosage may need to be adjusted for certain individuals.
Prerica and Kidney Function
Your kidneys play a crucial role in removing pregabalin from your body. If you have kidney problems, your doctor will likely adjust your Prerica dose. Dosage is determined based on your creatinine clearance (CrCl), which measures how well your kidneys are filtering waste products.
Table 1. Prerica Dosage Adjustment Based on Renal Function
| Creatinine Clearance (CrCl) (mL/min) | Total Prerica Daily Dose* | Dose Regimen | Starting Dose (mg/day) | Maximum Dose (mg/day) |
|---|---|---|---|---|
| ≥ 60 | 150 | BD (twice daily) | 150 | 300 |
| 30 – 60 | 75 | OD or BD (once or twice daily) | 75 | 150 |
| 15 – 30 | 25 – 50 | OD or BD (once or twice daily) | 25 – 50 | 75 |
| < 15 | 25 | OD (once daily) | 25 | 25 – 50 |
BD = Two divided doses; OD = Once daily
*Total daily dose (mg/day) should be divided as indicated by dose regimen to provide mg/dose +Supplementary dose is a single additional dose
For patients on haemodialysis, a supplementary dose of Prerica is given immediately after each 4-hour dialysis session because dialysis removes pregabalin from the blood.
Prerica and Liver Function
Good news for those with liver impairment: no dosage adjustment is needed. Your liver doesn’t play a major role in processing Prerica.
Prerica in Children
The safety and effectiveness of Prerica in children under 18 years old have not been established, so it is not typically prescribed for this age group.
Prerica in Older Adults
While generally safe for older adults, those with age-related kidney problems may need dosage adjustments, similar to those with kidney impairment in general.
Important Safety Information About Prerica
Before taking Prerica, it is crucial to be aware of potential side effects and precautions.
Who Should NOT Take Prerica?
- Hypersensitivity: Avoid Prerica if you are allergic to pregabalin or any of the inactive ingredients in the capsules.
Potential Side Effects of Prerica
Prerica, like all medications, can cause side effects. Some common side effects include:
- Dizziness
- Somnolence (sleepiness)
- Headache
- Ataxia (difficulty with coordination)
- Blurred vision
- Increased appetite
- Weight gain
- Dry mouth
- Constipation
Most of these side effects are mild and tend to go away on their own over time. However, if side effects are bothersome or don’t improve, it’s essential to inform your doctor.
Serious Side Effects
Although rare, Prerica can cause more serious side effects, including:
- Angioedema: This is a serious allergic reaction that causes swelling of the face, lips, tongue, and throat. It can be life-threatening and requires immediate medical attention.
- Withdrawal symptoms: These can occur if Prerica is stopped suddenly.
- Vision problems: Some people experience changes in vision while taking Prerica, including blurred vision, double vision, and even loss of vision.
- Renal failure: There have been reports of kidney problems associated with Prerica use.
- Congestive heart failure: This has been reported, particularly in older adults with pre-existing heart conditions.
- Suicidal ideation and behaviour: It’s crucial to be aware of any mood changes or thoughts of suicide and to seek medical help immediately.
- Reduced lower gastrointestinal tract function: This includes problems like constipation, intestinal obstruction, and paralytic ileus, especially when Prerica is used with opioids.
Precautions for Diabetic Patients
If you have diabetes and are taking Prerica, you might need to adjust your diabetes medication as Prerica can cause weight gain. It’s important to monitor your blood sugar levels carefully and talk to your doctor about any necessary changes to your diabetes treatment plan.
Prerica Interactions
Prerica may interact with other medications, so it’s essential to tell your doctor about all the medicines you take, including prescription and over-the-counter drugs, herbal supplements, and vitamins.
Medications that may interact with Prerica include:
- Opioids: Using Prerica with opioid pain relievers can increase the risk of central nervous system depression, leading to slowed breathing and even death. Your doctor will carefully monitor you if you need to take both medications.
- CNS depressants: Combining Prerica with other medications that depress the central nervous system, such as alcohol, benzodiazepines (like lorazepam), or sleep medications, can also enhance drowsiness and impair coordination.
- Oral contraceptives: Prerica doesn’t seem to affect the effectiveness of birth control pills.
- Other medications: While Prerica doesn’t generally have significant interactions with many common medications, including antidiabetics, diuretics, and many anti-epileptic drugs, it’s still essential to inform your doctor about all the medications you take.
Prerica Overdose
Overdosing on Prerica can be dangerous. Symptoms of an overdose might include:
- Excessive sleepiness
- Confusion
- Agitation
- Restlessness
- Seizures
- Coma (in rare cases)
If you suspect a Prerica overdose, seek emergency medical attention immediately. Treatment may involve general supportive measures and possibly haemodialysis to remove the drug from the blood.
Driving and Operating Machinery
Prerica can make you feel dizzy and sleepy, which can impair your ability to drive, operate machinery, or engage in other activities that require alertness and coordination. It’s crucial to avoid these activities until you know how Prerica affects you.
Prerica During Pregnancy and Breastfeeding
Pregnancy
If you are pregnant, planning to become pregnant, or breastfeeding, it’s essential to talk to your doctor before taking Prerica.
- Potential risks: There haven’t been enough studies to determine whether Prerica is safe to use during pregnancy. Animal studies have shown some reproductive toxicity.
- Recommendation: Due to the unknown risks, Prerica is generally not recommended for use during pregnancy. Effective contraception is essential for women of childbearing potential taking Prerica.
Breastfeeding
- Excretion in breast milk: Pregabalin, the active ingredient in Prerica, passes into breast milk.
- Potential effects on infants: The effects of pregabalin on breastfed infants are unknown.
- Recommendation: Breastfeeding while taking Prerica is not recommended.
Understanding Prerica‘s Pharmacokinetic Properties
Pharmacokinetics refers to how a medication is absorbed, distributed, metabolised, and eliminated from the body. Understanding Prerica‘s pharmacokinetics can help explain how it works and why dosage adjustments are necessary in certain situations.
Absorption
- Rapid absorption: Prerica is quickly absorbed into the bloodstream after you take it orally. Peak blood levels are reached within an hour, whether taken as a single dose or multiple doses.
- High bioavailability: This means that a high percentage of the drug (≥ 90%) enters the bloodstream and becomes active in the body.
- Food effects: Taking Prerica with food slows down the absorption rate slightly but doesn’t significantly affect the total amount of drug absorbed.
- Steady state: After taking Prerica regularly, it reaches a stable level in the bloodstream within 24 to 48 hours.
Distribution
- Wide distribution: Prerica is distributed throughout the body and can cross the blood-brain barrier, which is essential for its effect on nerve pain.
- Lack of protein binding: This means that the drug is readily available to reach its target sites.
Metabolism
- Minimal metabolism: Prerica undergoes very little metabolism (breakdown) in the body. Most of the drug is excreted unchanged in the urine.
Elimination
- Primarily renal excretion: The kidneys are the main route of elimination for Prerica.
- Half-life: The half-life of Prerica is about 6.3 hours, which means that it takes about 6.3 hours for half of the drug to be eliminated from the body.
- Creatinine clearance impact: The rate at which Prerica is cleared from the body is directly related to creatinine clearance, a measure of kidney function.
Age and Kidney Function
- Age-related decline in clearance: As people age, their kidney function often declines, leading to slower clearance of Prerica.
- Renal impairment: Individuals with kidney problems have reduced clearance of Prerica and may require dosage adjustments to avoid drug build-up in the body.
Additional Information about Prerica
Manufacturer
Prerica is manufactured by Austell Pharmaceuticals (Pty) Ltd in South Africa.
Inactive Ingredients (Excipients)
The inactive ingredients, or excipients, in Prerica capsules help with the medication’s formulation, stability, and delivery. They include:
- Capsule fill content: Mannitol, co-processed compendial corn starch and compendial pregelatinized corn starch, and talc.
- Hard Capsule Body: Gelatin, Iron Oxide Red (E172), Titanium Dioxide (E171).
- Hard Capsule Cap: Gelatin, Iron Oxide Red (E172), Titanium Dioxide (E171).
- Printing ink (Black): Black Iron Oxide (E172), potassium hydroxide, and shellac.
Storage
Prerica should be stored at or below 25°C (77°F) to maintain its quality and effectiveness.
Important note: This blog post provides general information about Prerica but should not be considered medical advice. Always consult with a healthcare professional for personalized medical guidance and before making any decisions related to your treatment.
Dr. Ahmad Baker, PharmD
Senior Pharmacist & Health Educator
With over 23 years of clinical experience in hospital and community pharmacy across Egypt and Saudi Arabia, Dr. Ahmad specializes in reproductive health and pharmaceutical safety. He is dedicated to providing evidence-based guidance to empower patients in the MENA region.
Medical Disclaimer: This content is for educational purposes and reflects the latest pharmaceutical protocols. It is not a substitute for personal medical advice. Always consult Dr. Ahmad Baker or your healthcare provider before starting any treatment.