New on this drug. Experiences?

[MyNameIsTerry]

Thanks for info Terry, is that what you had to do to get it?

---------- Post added at 12:23 ---------- Previous post was at 12:12 ----------

Can you only access the local and BNF if you have an account?

I've not been on it, I just find it interesting to discuss and I'm used to searching for things like this from a previous job so I try and help where I can when people are being bluffed by GP's.

For the BNF you do need an account but quite a bit, including the med licence stuff, can be accessed via Google search or you should be able to get it in the BNF search on the NICE website.

Here is the BNF one:

http://www.evidence.nhs.uk/formulary...lin/pregabalin

Medicines Complete took over I think but you can search the BNF through the NICE website by clicking on their Evidence Services tab.

The local ones I don't know as they are individual. When I checked the Buckinghamshire one I could read their prescribing info for all meds.

Here is an example of what you might see:

http://www.derbyshiremedicinesmanage...ug/pregabalin/

Here is the NICE guidance showing use of Pregabalin:

http://www.nice.org.uk/guidance/cg11...ter/1-Guidance

Drug treatment

1.2.22 If a person with GAD chooses drug treatment, offer a selective serotonin reuptake inhibitor (SSRI). Consider offering sertraline first because it is the most cost-effective drug, but note that at the time of publication (January 2011) sertraline did not have UK marketing authorisation for this indication. Informed consent should be obtained and documented. Monitor the person carefully for adverse reactions. [new 2011]

1.2.23 If sertraline is ineffective, offer an alternative SSRI or a serotonin–noradrenaline reuptake inhibitor (SNRI), taking into account the following factors:
•tendency to produce a withdrawal syndrome (especially with paroxetine and venlafaxine)
•the side-effect profile and the potential for drug interactions
•the risk of suicide and likelihood of toxicity in overdose (especially with venlafaxine)
•the person's prior experience of treatment with individual drugs (particularly adherence, effectiveness, side effects, experience of withdrawal syndrome and the person's preference). [new 2011]

1.2.24 If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin. [new 2011]

1.2.25 Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the 'British national formulary' on the use of a benzodiazepine in this context. [new 2011]

1.2.26 Do not offer an antipsychotic for the treatment of GAD in primary care. [new 2011]

1.2.27 Before prescribing any medication, discuss the treatment options and any concerns the person with GAD has about taking medication. Explain fully the reasons for prescribing and provide written and verbal information on:
•the likely benefits of different treatments
•the different propensities of each drug for side effects, withdrawal syndromes and drug interactions
•the risk of activation with SSRIs and SNRIs, with symptoms such as increased anxiety, agitation and problems sleeping
•the gradual development, over 1 week or more, of the full anxiolytic effect
•the importance of taking medication as prescribed and the need to continue treatment after remission to avoid relapse. [new 2011]

1.2.28 Take into account the increased risk of bleeding associated with SSRIs, particularly for older people or people taking other drugs that can damage the gastrointestinal mucosa or interfere with clotting (for example, NSAIDS or aspirin). Consider prescribing a gastroprotective drug in these circumstances. [new 2011]

1.2.29 For people aged under 30 who are offered an SSRI or SNRI:
•warn them that these drugs are associated with an increased risk of suicidal thinking and self-harm in a minority of people under 30 and
•see them within 1 week of first prescribing and
•monitor the risk of suicidal thinking and self-harm weekly for the first month. [new 2011]

1.2.30 For people who develop side effects soon after starting drug treatment, provide information and consider one of the following strategies:
•monitoring the person's symptoms closely (if the side effects are mild and acceptable to the person) or
•reducing the dose of the drug or
•stopping the drug and, according to the person's preference, offering either
◦an alternative drug (see 1.2.23–1.2.24) or
◦a high-intensity psychological intervention (see 1.2.17–1.2.21). [new 2011]

1.2.31 Review the effectiveness and side effects of the drug every 2–4 weeks during the first 3 months of treatment and every 3 months thereafter. [new 2011]

1.2.32 If the drug is effective, advise the person to continue taking it for at least a year as the likelihood of relapse is high. [new 2011]


NICE don't cover Scotland but they have an agreement with your equivalent:

http://www.sign.ac.uk/about/niceandsign.html

Last I looked they had no guidance for any anxiety disorder but there current list is here if you want to check:

http://www.sign.ac.uk/guidelines/published/index.html

Your SMC seem to blame it on the manufacturer for not pursuing the licence:

http://www.scottishmedicines.org.uk/...olution_Lyrica

However, it could be done "off label" and considering it is licenced in England & Wales, it's seems like a political technicality to me.

This is Albert's thread with the study scrutiny in:

http://www.nomorepanic.co.uk/showthread.php?t=164816

I did post one somewhere showing over 200 CCG's and how much they had spent per year on this med but I can't seem to find it.

---------- Post added at 07:14 ---------- Previous post was at 07:00 ----------

Thanks hanshan & Albert, merely echoing your wise words on here.

[shiznit76]

I've not been on it, I just find it interesting to discuss and I'm used to searching for things like this from a previous job so I try and help where I can when people are being bluffed by GP's.

For the BNF you do need an account but quite a bit, including the med licence stuff, can be accessed via Google search or you should be able to get it in the BNF search on the NICE website.

Here is the BNF one:

http://www.evidence.nhs.uk/formulary...lin/pregabalin

Medicines Complete took over I think but you can search the BNF through the NICE website by clicking on their Evidence Services tab.

The local ones I don't know as they are individual. When I checked the Buckinghamshire one I could read their prescribing info for all meds.

Here is an example of what you might see:

http://www.derbyshiremedicinesmanage...ug/pregabalin/

Here is the NICE guidance showing use of Pregabalin:

http://www.nice.org.uk/guidance/cg11...ter/1-Guidance

Drug treatment

1.2.22 If a person with GAD chooses drug treatment, offer a selective serotonin reuptake inhibitor (SSRI). Consider offering sertraline first because it is the most cost-effective drug, but note that at the time of publication (January 2011) sertraline did not have UK marketing authorisation for this indication. Informed consent should be obtained and documented. Monitor the person carefully for adverse reactions. [new 2011]

1.2.23 If sertraline is ineffective, offer an alternative SSRI or a serotonin–noradrenaline reuptake inhibitor (SNRI), taking into account the following factors:
•tendency to produce a withdrawal syndrome (especially with paroxetine and venlafaxine)
•the side-effect profile and the potential for drug interactions
•the risk of suicide and likelihood of toxicity in overdose (especially with venlafaxine)
•the person's prior experience of treatment with individual drugs (particularly adherence, effectiveness, side effects, experience of withdrawal syndrome and the person's preference). [new 2011]

1.2.24 If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin. [new 2011]

1.2.25 Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the 'British national formulary' on the use of a benzodiazepine in this context. [new 2011]

1.2.26 Do not offer an antipsychotic for the treatment of GAD in primary care. [new 2011]

1.2.27 Before prescribing any medication, discuss the treatment options and any concerns the person with GAD has about taking medication. Explain fully the reasons for prescribing and provide written and verbal information on:
•the likely benefits of different treatments
•the different propensities of each drug for side effects, withdrawal syndromes and drug interactions
•the risk of activation with SSRIs and SNRIs, with symptoms such as increased anxiety, agitation and problems sleeping
•the gradual development, over 1 week or more, of the full anxiolytic effect
•the importance of taking medication as prescribed and the need to continue treatment after remission to avoid relapse. [new 2011]

1.2.28 Take into account the increased risk of bleeding associated with SSRIs, particularly for older people or people taking other drugs that can damage the gastrointestinal mucosa or interfere with clotting (for example, NSAIDS or aspirin). Consider prescribing a gastroprotective drug in these circumstances. [new 2011]

1.2.29 For people aged under 30 who are offered an SSRI or SNRI:
•warn them that these drugs are associated with an increased risk of suicidal thinking and self-harm in a minority of people under 30 and
•see them within 1 week of first prescribing and
•monitor the risk of suicidal thinking and self-harm weekly for the first month. [new 2011]

1.2.30 For people who develop side effects soon after starting drug treatment, provide information and consider one of the following strategies:
•monitoring the person's symptoms closely (if the side effects are mild and acceptable to the person) or
•reducing the dose of the drug or
•stopping the drug and, according to the person's preference, offering either
◦an alternative drug (see 1.2.23–1.2.24) or
◦a high-intensity psychological intervention (see 1.2.17–1.2.21). [new 2011]

1.2.31 Review the effectiveness and side effects of the drug every 2–4 weeks during the first 3 months of treatment and every 3 months thereafter. [new 2011]

1.2.32 If the drug is effective, advise the person to continue taking it for at least a year as the likelihood of relapse is high. [new 2011]


NICE don't cover Scotland but they have an agreement with your equivalent:

http://www.sign.ac.uk/about/niceandsign.html

Last I looked they had no guidance for any anxiety disorder but there current list is here if you want to check:

http://www.sign.ac.uk/guidelines/published/index.html

Your SMC seem to blame it on the manufacturer for not pursuing the licence:

http://www.scottishmedicines.org.uk/...olution_Lyrica

However, it could be done "off label" and considering it is licenced in England & Wales, it's seems like a political technicality to me.

This is Albert's thread with the study scrutiny in:

http://www.nomorepanic.co.uk/showthread.php?t=164816

I did post one somewhere showing over 200 CCG's and how much they had spent per year on this med but I can't seem to find it.

---------- Post added at 07:14 ---------- Previous post was at 07:00 ----------

Thanks hanshan & Albert, merely echoing your wise words on here.

Thanks soooooo much Terry, your help and knowledge is amazing!

[MyNameIsTerry]

Thanks soooooo much Terry, your help and knowledge is amazing!

Add this to your case:

https://www.gov.uk/government/organi...sponsibilities

Note they licence meds for the UK. I don't know where the Scottish board come into this, whether maybe they apply a licence afterwards? But since the MHRA have licenced Pregabalin for GAD, we can certainly have it down here so it's a possible argument?

The licencing docs are here:

http://www.mhra.gov.uk/spc-pil/?IdcS...tSearch=Search

I would have a look through those and see what you find.

[shiznit76]

you should be a lawyer Terry!

I'm due back at my doc a week Tuesday, so will have a decent case made for him by then! Hopefully. Previously I mentioned it in passing to him and he totally ruled it out. however, now I have tried r SSRI's, an SNRI, and even a TCA I can't see why I shouldn't be tired on Pregab

[Ssmith]

Hey guys,

So I'm on the 2nd day on my pregabalin, 75mg twice a day. I'm feeling anxious but not as bad as yesterday. I don't know if this is due to the drug, or that i had my first IAPT appointment this morning and then went for a blood test which usually panics me. So i don't know if I'm feeling better because I've overcome something that panics me.

Either way, it's nice to feel a little less anxious. I've noticed no side effects whatsoever from starting the pregabalin. I've had 3 doses so far and have decided to come off the citalopram. I was on 10mg anyway and I feel like it was doing absolutely nothing. I decided to stick on the 10mg for so long for a 'psychological safety net'.

Hopefully I'll see more benefits as the days go on. From what i understand, it takes about a week to kick in? I'm still worrying about if and when i have to come off this medication, I'll have severe withdrawals as i read somewhere pregabalin should only be used short term?

[unfitwellhappy]

I'll have severe withdrawals as i read somewhere pregabalin should only be used short term?

I'm a long term user of pregabalin (2+ years) for anxiety..

They're not addictive per say but I have experienced withdrawals when lowering my dose but these are absolutely to be expected just due to their mechanism of action.

Anyway, the 'withdrawal' was pretty uncomfortable from a psychological point of view but it was really only a return to baseline anxiety (albeit slightly lower than) which always eased off maybe after 10 days - rebound anxiety is to expected (completely normal for most psych meds).

There's absolutely no physical withdrawals (unlike opiates/benzos) unless you are taking it for seizures etc then there's a little risk.

[hanshan]

Hi Ssmith,

I'm also a pregabalin long-term user, and have found it has kept working throughout with no need to change dosage after the initial settling in period. Best wishes for your progress.

[shiznit76]

Hi Ssmith,

I'm also a pregabalin long-term user, and have found it has kept working throughout with no need to change dosage after the initial settling in period. Best wishes for your progress.

Are you taking it for GAD?

[Ssmith]

Thanks for the response and reassurance guys. And yeah taking it for GAD. I've been a real mess the last 4 or 5 months and was willing to try anything. I'm also starting to come to the realisation that medication isn't everything, no matter how bad i am, and i need to look at changing my response to things. I've always just focused on medication and thought there's no point in trying to get better until i find a med that works. I realise that's the wrong attitude to have now

[SmilingAlbert]

Hi Ssmith,

Glad to hear you're feeling a bit better. One of the best aspects of this medicine is that it often works pretty quickly at start-up, and as you have experienced, side-effects are low for most people.

As I've said before, one day I hope this medicine will go to the top of the list for GAD, as my experience of the first-line (SSRIs etc.) is that they take an already anxious person, and shove their anxiety through the roof for a period.

Which is very bad - I have been there. Good luck on your recovery and keep us posted.

Albert