Lyrica Gabapentin: an Easy Switch!

Pharmacist Contacts: [email protected]; [email protected]; [email protected] Lyrica Gabapentin: An Easy Switch! Conversion between Lyrica and gabapentin is generally Daily Dose of Daily Dose of Shingrix well tolerated and direct switching minimizes potential for Gabapentin Lyrica Reactogenicity gaps in pain relief. In the absence of seizure history, the (mg/day) (mg/day) drugs can be directly interchanged; patients can be advised 0 – 300 50 to discontinue Lyrica and begin gabapentin the following When giving Shingrix, day. Patients with a seizure history should be cross-tapered 301 – 450 75 counsel patients about over 1 – 4 weeks. 451 – 600 100 expected reactions. 601 – 900 150 While cross-tolerance is expected, patients should be 901 – 1200 200 advised adverse effects such as drowsiness or edema may There is a 10% chance of 1201 – 1500 250 still emerge when therapy is changed but tend to decrease developing a grade 3 1501 – 1800 300 injection site reaction with time. A conservative approach may be useful to 1801 – 2100 350 and/or systemic mitigate adverse effects. reactions (see table 2101 – 2400 400 Titration of gabapentin to the maximum tolerated 2401 – 2700 450 below) – these symptoms therapeutic dose is important. The therapeutic dosing 2701 – 3000 500 were significant enough range in neuropathic pain trials is 1800-3600 mg/day to prevent regular (normal renal function). The pharmacokinetics of 3001 – 3600 600 activities in about 17% of gabapentin require regular dosing, it will not work if clinical trial patients, but dosed “as needed.” Studies show minimal benefit & tend to pass within 2-3 more adverse effects when high days. Despite its therapeutic role in neuropathic pain, Lyrica doses are used for diabetic gabapentin, like Lyrica, does have abuse potential. This neuropathy (>300 mg/day) and Injection Pain, reinforces the importance of ensuring each patient taking fibromyalgia (>450 mg/day) site redness, gabapentin has an appropriate indication, dose and reaction swelling frequency to maximize benefit and avoid adverse events Systemic Myalgia, or misuse. reaction fatigue, headache, Admelog (insulin lispro): Testosterone Formulations fever, first follow-on biologic for rapid-acting insulin There is significant variation in the costs of different testosterone formulations. Dosage form, GI upset Its comparator product is Humalog. Admelog strength, duration of use, and product was approved through the same pathway as A patient’s reaction to manufacturer impact the cost of treatment. Basaglar, an alternative to Lantus. Admelog was the first dose is not non-inferior to Humalog in A1c lowering with a This variation makes a targeted cost-effective necessarily predictive similar incidence of adverse reactions for both prescribing initiative difficult, but we worked with of a reaction to the T1DM and T2DM. our Specialist Advisory Committee to provide second dose of some general guidance on to help providers select Excellus Managed Medicaid is changing its Shingrix. Encourage a cost-effective testosterone dosage form: formulary coverage for rapid-acting insulin*: patients to complete Depot IM injections tend to be the cheapest Starting 5/1/18, new prescriptions should be the series even if they given their extended duration written for Admelog to avoid coverage gaps have a grade 1-3 o Cypionate and enanthate esters are similar Starting 6/15/18, existing rapid-acting insulin reaction to their first in cost users will need to be switched to Admelog dose. Transdermal gels are more popular but are *Humalog/Novolog/Apidral no longer covered more expensive The switch: conversion from Humalog is 1:1 o Generics are less expensive than brands o Packets are less expensive than pumps Regulatory standards prevent pharmacists from directly substituting Admelog for Humalog, so Other formulations (solutions, buccal tablets, prescriptions will need to be written specifically patches) tend to be more expensive per gram for Admelog. of testosterone delivered .

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