The gabapentin patent was running out, so Pfizer synthesized a related molecule that did the same thing, hyped it up as the hot new thing, and charged 50x what gabapentin cost. On the face of things, pregabalin seems like another Big Pharma ploy to extend patents. Pregabalin officially went generic last month, but isn’t available yet in generic form, so you’ll have to pay Pfizer $500 a month. I haven’t had much luck finding patients a dose that works well but doesn’t have these side effects, which is why I don’t use gabapentin much. At the high end, it can cause sedation, confusion, dependence, and addiction. Most doctors (including me) use it at the low end, where it’s pretty subtle (read: doesn’t usually work). It has an unusually wide dose range: guidelines suggest using anywhere between 100 mg and 3600 mg daily. It’s commonly used for seizures, nerve pain, alcoholism, drug addiction, itching, restless legs, sleep disorders, and anxiety. Two gabapentinoids are approved by the FDA: gabapentin (Neurontin®) and pregabalin (Lyrica®). Although they were developed to imitate GABA’s action, later research discovered they acted on a different target, the A2D subunit of calcium channels. The gabapentinoids are a class of drugs vaguely resembling the neurotransmitter GABA.
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