148553-50-8 Usage
Description
As a follow-up to its g-aminobutyric acid (GABA) agonist gabapentin, Pfizer has
developed and launched pregabalin for the treatment of epilepsy and neuropathic
pain. Although pregabalin is a structural analog of GABA, it does not interact with
GABA-A or GABA-B receptors or influence GABA uptake. The exact mechanism
of action is unclear, but pregabalin may reduce excitatory neurotransmitter release
by binding to the α2-δ protein subunit of voltage-gated calcium channels. The
resulting inhibition of excess neuronal activity is believed to be the basis for
pregabalin’s efficacy in epilepsy and neuropathic pain alleviation. Since the activity
is attributed to the (S′)-enantiomer alone, an efficient asymmetric synthesis is employed
for commercial production. The key step is the asymmetric hydrogenation
of 3-cyano-5-methyl-3-hexenoic acid using a chiral rhodium catalyst to afford an
intermediate that is enriched in the (S′)-enantiomer. The cyano group is ultimately
reduced by routine hydrogenation with a nickel catalyst. Further enrichment of the
final product is realized by selective recrystallization with (S′)-mandelic acid or
simply recrystallizing from water/isopropanol. Compared to gabapentin, pregabalin
is 2- to 10-fold more potent in various animal models. For example, in
preventing maximal electroshock seizures (MES) in mice, pregabalin has an ED50 of
20 mg/kg p.o. versus 87 mg/kg for gabapentin. A comparable increase in potency is
also observed in the rat MES model (ED50=1.8mg=kg p.o. for pregabalin versus
10.3 mg/kg for gabapentin). In addition, pregabalin’s linear pharmacokinetics (Cmax
relates to dose) translates to better predictability of pharmacological effects. It has
90% oral bioavailability, with an elimination half-life of approximately 6 h. The
primary route of excretion is via the renal system with negligible metabolism. Furthermore,
its lack of activity at the cytochrome P450 enzymes was reflected in an
absence of pharmacokinetic drug-drug interactions in relevant studies. In a placebocontrolled,
fixed dose (up to 600mg/day) trial with pregabalin as an adjunctive therapy
for epilepsy, 14 to 51% of patients showed at least a 50% decrease in seizure frequency
with a clear dose-response relationship. In a flexible dosing group, (150 mg/day to
600 mg/day), the seizure reduction rate was 35.4%compared to 40.3% for a fixed dose
of 600mg/day and 10.6% for placebo. The most common side effects were dizziness
(29%) and somnolence (21%). In addition, weight gain (equal to or more than 7%
increase from baseline) occurred in 40% of patients in the 12-week study; however,
there was no affect on male fertility or efficacy of oral contraceptives in
women. Regarding the use of pregabalin in treating painful diabetic peripheral
neuropathy, oral administration of 300 and 600 mg/day t.i.d. was superior to placebo
(39–48% compared to 15–18% with placebo) in relieving pain and improving
pain-related sleep interference. While pregabalin was originally developed as an
anticonvulsant for epilepsy, its success in treating neuropathic pain has led to its
exploration in treating other CNS disorders, such as, anxiety, social phobia, and
fibromyalgia.
Dose titration
Epilepsy— adjunctive therapy: 25 mg bd for 7 days, to be increased by 50 mg every 7days; usual maintenance 300 mg daily, divided into 2 or 3 doses (max. 600 mg daily, divided into 2 or 3 doses).
Generalized anxiety disorder: 150 mg daily, divided into 2 or 3 doses, for 7 days, to be increased by 150 mg every 7 days (max. 600 mg daily, divided into 2 or 3 doses).
If stopping pregabalin, it is recommended to taper over at least 1?week to avoid abrupt withdrawal.
Uses
S-Enantiomer of Pregabalin. A GABA analogue used as an anticonvulsant. Anxiolytic analgesic used to treat peripheral neuropathic pain and fibromyalgia.
Indications
Epilepsy
Adjunctive therapy of focal seizures with and without secondary generalization.
Recommendations summarized from NICE (2012)
Seizure types—on referral to tertiary care (focal seizures), contraindicated (generalized tonic- clonic seizures, tonic/ atonic seizures, absence seizures, myoclonic seizures).
Epilepsy types—on referral to tertiary care (benign epilepsy with centrotemporal spikes, panayiotopoulos syndrome, late- onset childhood occipital epilepsy), contraindicated (absence syndromes, idiopathic generalized epilepsy, juvenile myoclonic epilepsy, Dravet syndrome, Lennox– Gastaut syndrome).
Psychiatry
Generalized anxiety disorder.
Neurology
Peripheral and central neuropathic pain.
Psychiatric use
Pregabalin has an approved indication and is widely used for the treatment of generalized anxiety disorder. Several randomized, double- blind, placebocontrolled trials found that pregabalin is an effective treatment for patients with generalized anxiety disorder and social anxiety disorder. Possible implications in the treatment of mood disorders and benzodiazepines dependence are emerging. Moreover, pregabalin may be a therapeutic agent for the treatment of alcohol abuse, in both withdrawal phase and relapse prevention.
Generic formulation
MHRA/ CHM advice to minimize risk when switching patients with epilepsy between different manufacturers’ products (including generic products):
It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific concerns, such as patient anxiety and risk of confusion/ dosing error.
Adverse effects
Pregabalin can be associated with adverse effects at the level of the nervous system and other systems.
Antiepileptic drus and therapeutic drugs for neuropathic pain
Pregabalin is a new antiepileptic drug, having a γ-amino butyric acid structure on its molecular structure, which has anticonvulsant effects, and is successfully developed by the company Pfizer for the treatment of peripheral neuropathic pain, or adjuvant treatment of partial seizures.
In December 2008, the US Food and Drug Administration (FDA) approved pregabalin (trade name "Lyrica") for the treatment of diabetic peripheral neuropathic pain (DPN) and postherpetic neuralgia (PHN)which are Both the most common neuropathic pains.
Neuropathic pain is one of the most difficult chronic pain syndromes to treat , dull pain, burning, tingling as the main feature, there are a lot of incentives of neuralgia, diabetes, infections (such as herpes zoster), cancer and AIDS, etc. can cause neurological pain, in Europe about 3% of the population suffer from neuralgia torture.
The above information is edited by the chemicalbook of Tian Ye.
Special populations
Hepatic impairment
No dose adjustment is required for patients with hepatic impairment.
Renal impairment
Reduce maintenance dose according to degree of reduction in creatinine clearance.
Pregnancy
There is no adequate data from the use of pregabalin in pregnant women. The potential risk for reproductive toxicity in humans is unknown. Pregabalin should not be used during pregnancy unless the benefit to the mother clearly outweighs the potential risk to the foetus.
Pregabalin is excreted into human milk. The effect of pregabalin on newborns/ infants is unknown. A case- by- case decision must be made whether to discontinue breast- feeding or to discontinue pregabalin therapy taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman.
Description
Pregabalin is a second- generation antiepileptic drug (AED) known with the proprietary brand name of Lyrica? (Pfizer, Tadworth) in the UK and USA (Pfizer, New York, NY).
Chemical Properties
Off-White Solid
Interactions
Since pregabalin is predominantly excreted unchanged in the urine, undergoes negligible metabolism in humans, does not inhibit drug metabolism in vitro, and is not bound to plasma proteins, it is unlikely to produce or be subject to pharmacokinetic interactions.
Pregabalin may potentiate the effects of lorazepam.
In the post- marketing experience, there are reports of respiratory failure and coma in patients taking pregabalin and other central nervous system depressant medicinal products. Pregabalin appears to be additive in the impairment of cognitive and gross motor function caused by oxycodone.
With alcohol/food
There are no specific foods that must be excluded from diet when taking pregabalin.
Pregabalin may potentiate the effects of alcohol.
Brand name
Lyrica (CP).
Originator
Warner-Lambert (US)
Cautions
Patients with conditions that may precipitate encephalopathy.
Patients with severe congestive heart failure.
Plasma levels monitoring
Pregabalin pharmacokinetics are linear over the recommended daily dose range; inter- subject pharmacokinetic variability for pregabalin is low (<20%) and multiple dose pharmacokinetics are predictable from single- dose data. Therefore, there is no need for routine monitoring of plasma concentrations of pregabalin.
Behavioural and cognitive effects in patients with epilepsy
Pregalin is characterized by a good behavioural profile. This AED does not appear to have significant negative effects on mood or behaviour in patients with epilepsy, although depression has been reported in some patients (dose- dependent effects of mild- to- moderate intensity). A potential abuse or misuse of pregabalin has also been reported, with implications in terms of dependence and withdrawal. pregabalin is also associated with limited negative cognitive effects, mainly related to sedation, decreased arousal, decreased attention and concentration (dose- dependent effects of mild- to- moderate intensity).
Chemical Synthesis
Several syntheses of pregabalin (X) have been disclosed in the literature, including process scale-up comparison of
several different routes. The most cost efficient route
as described in the publication is shown in the Scheme.
Condensation of diethyl malonate 69 in the presense of
diisopropyl amine in acetic acid gave a,b-unsaturated diester
70 in high yield. Reaction of the enone diester with
potassium cyanide gave cyano diester 71 in 95% yield. In a
remarkable three step, one pot process, the nitrile in 71 was
hydrolyzed followed by decarboxylation of one of the esters
to provide 72 in 73% yield. Resolution of the two
enantiomers was achieved using (S)-(+)-mandellic acid, one
of the best acid found after many salt screening, to give, after
two recrystallization, a 99:1 ratio of the desired diastereomer.Removal of the acid was done with wet THF instead of base
separation, to avoid salt impurities, and one recrystallization
in ethanol gave 100% ee diastereomer in 25 – 29% overall
yield.It’s worth noting that the Pfizer group have come up
with a new process of preparing pregabalin (X) via
enantioselective reduction, that promises to further reduce
cost and waste associated with the manufacture of this drug.
Uses
Pregabalin is an anticonvulsant drug used for neuropathic pain, as an adjunct therapy for partial seizures, and in generalized anxiety disorder. It was designed as a more potent successor to gabapentin. Pregabalin is marketed by Pfizer under the trade nam
InChI:InChI=1/C8H17NO2/c1-6(2)3-7(5-9)4-8(10)11/h6-7H,3-5,9H2,1-2H3,(H,10,11)/t7-/m0/s1