1. Low risk of sexual dysfunction versus placebo
Incidence of sexual dysfunction (% of patients)
Pregabalin (n=1149)
Placebo
(n=484)
Libido decreased 2 1
Anorgasmia
Abnormal ejaculation* 4
Impotence* 3
Treatment-emergent adverse events related to sexual dysfunction were very infrequent in pregabalin clinical trials
Although the incidences of these adverse events in the pregabalin treatment group were slightly higher than placebo, they were very infrequent
Reference
Data on file – PGB023 (AE summary GAD) Pfizer Ltd.
*Incidence in men.
Data on file – PGB023 (AE summary GAD) Pfizer Ltd.
LYG100 January 2009 1

2. Hepatically impaired patients
Pregabalin may be useful due to renal clearance!
Predominantly excreted unchanged in the urine
Does not inhibit drug metabolism in vitro
Is not bound to plasma proteins
Hence unlikely to produce or subject to pharmacokinetic interactions

3. NICE Clinical Guideline 113 (January 2011)
For patients:
If antidepressants are not suitable for you, you may be offered pregabalin.
For prescribers:
If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin.

4. Efficacy vs. effectiveness of benzodiazepines systematic review and meta-analysis of RCTs
Withdrawals due to lack of efficacy
Withdrawals for any reason
Martin JLR et al. J Psychopharmacol 2007; 21:

5. % of patients receiving >1 year’s treatment by age

6. Withdrawal features with BZDs
They have notorious reputation with the public
Little or no dose escalation yet physical dependence
Characteristic withdrawal syndrome (“sedative/alcohol”) - often bizarre symptoms - claims for prolonged syndrome
Can be hazardous - fits, psychosis
Poor outcome, especially in the elderly

7. BDZ’s (Not recommended by NICE for long term use!)
May be needed In short term acute situations
May be needed as adjunctive treatments with AD’s, anticonvulsants or psychological Treatments
Issues are side effects (sedation and cognitive effects) and dependence in long term use
Not as good for psychic symptoms (antidepressants better)
More 3rd line after SSRI’s or Anticonvulsants and or psychological treatments
Should be reserved and used in persistent, severe , disabling , refractory illnesses
Regular not PRN Diazepam, Clonazepam (1-4mg) is better in chronic anxiety than Lorazepam, Alprazolam due longer half life and slower absorption so less dependence potential

8. If some one is already taking BDZ more than 4 times a week
Start SSRI’s build it up to therapeutic doses in 4-6 weeks and continue for 12 weeks before attempting to withdraw
If you get to a stage where you cannot get any further..
Substitute short acting drugs with long acting ones to make tapering easier!
May need some Beta blockers/CBT at end stages of withdrawal
Some patients may need both!

9. Azapirones in acute treatment of GAD
efficacious in acute treatment especially if benzodiazepine-naïve
P’s who have recently withdrawn from BDZ’s may suffer more symptoms as Buspirone has no effect on BDZ withdrawal syndrome
less well tolerated than benzodiazepines and less effective than BDZ’s
Chessick CA et al. Cochrane Database Syst Rev 2006; 3: CD006115