| chronic pain (diagnosis)
Butrans vs Lyrica
Side-by-side clinical, coverage, and cost comparison for chronic pain (diagnosis).Deep comparison between: Butrans vs Lyrica with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsLyrica has a higher rate of injection site reactions vs Butrans based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Lyrica but not Butrans, including UnitedHealthcare
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Category
Butrans
Lyrica
At A Glance
Transdermal patch
Every 7 days
Partial mu-opioid agonist
Oral
2-3 times daily
alpha2-delta calcium channel ligand
Indications
- chronic pain (diagnosis)
- Peripheral Nervous System Diseases
- Epilepsy
- Fibromyalgia
- chronic pain (diagnosis)
Dosing
chronic pain (diagnosis) For opioid-naive patients, initiate with BUTRANS 5 mcg/hour transdermal patch worn for 7 days; for patients on 30-80 mg/day oral morphine equivalents, taper current opioid to <=30 mg/day then initiate at 10 mcg/hour; maximum dose is 20 mcg/hour (one system); titrate no more frequently than every 72 hours in increments of 5, 7.5, or 10 mcg/hour.
Peripheral Nervous System Diseases Begin at 150 mg/day in 3 divided doses; may increase to max 300 mg/day within 1 week; oral.
chronic pain (diagnosis) PHN: begin at 150 mg/day (75 mg BID or 50 mg TID), max up to 600 mg/day. Spinal cord injury neuropathic pain: begin at 150 mg/day (75 mg BID), max 600 mg/day; oral.
Epilepsy Adults: begin at 150 mg/day in 2 or 3 divided doses, max 600 mg/day. Pediatric >=30 kg: begin 2.5 mg/kg/day, max 10 mg/kg/day. Pediatric <30 kg: begin 3.5 mg/kg/day, max 14 mg/kg/day; oral.
Fibromyalgia Begin at 150 mg/day (75 mg BID); may increase to 300 mg/day within 1 week; max 450 mg/day; oral.
Contraindications
- Significant respiratory depression
- Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus
- Hypersensitivity (e.g., anaphylaxis) to buprenorphine or any excipient
- Known hypersensitivity to pregabalin or any of its components
Adverse Reactions
Most common (>=5%) Nausea, headache, application site pruritus, dizziness, constipation, somnolence, vomiting, application site erythema, dry mouth, application site rash
Serious Life-threatening respiratory depression, addiction/abuse/misuse, interactions with CNS depressants, neonatal opioid withdrawal syndrome, QTc prolongation, anaphylaxis/allergic reactions, hepatotoxicity, seizures, adrenal insufficiency, severe hypotension
Postmarketing Serotonin syndrome, adrenal insufficiency, anaphylaxis, androgen deficiency, hyperalgesia and allodynia, hypoglycemia, opioid-induced esophageal dysfunction
Most common (>=5%) Dizziness, somnolence, dry mouth, edema, blurred vision, weight gain, thinking abnormal
Serious Angioedema, hypersensitivity, suicidal behavior and ideation, respiratory depression, peripheral edema, weight gain, tumorigenic potential, ophthalmological effects, creatine kinase elevations, decreased platelet count, PR interval prolongation
Postmarketing Headache, nausea, diarrhea, gynecomastia, breast enlargement, bullous pemphigoid, life-threatening respiratory depression with opioids or CNS depressants
Pharmacology
Buprenorphine is a partial agonist at the mu-opioid receptor, an antagonist at kappa-opioid receptors, an agonist at delta-opioid receptors, and a partial agonist at ORL-1 (nociceptin) receptors; it produces analgesia and respiratory depression via central opioid receptor modulation, with pharmacodynamic effects including CNS depression, reduced GI motility, and peripheral vasodilation.
Pregabalin binds with high affinity to the alpha2-delta site (an auxiliary subunit of voltage-gated calcium channels) in CNS tissues, reducing calcium-dependent release of pro-nociceptive neurotransmitters in the spinal cord and exerting antiseizure effects; it is a structural GABA analogue but does not act directly on GABA receptors, sodium channels, or opiate receptors.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Butrans
- Covered on 5 commercial plans
- PA (11/12) · Step Therapy (0/12) · Qty limit (10/12)
Lyrica
- Covered on 5 commercial plans
- PA (0/12) · Step Therapy (0/12) · Qty limit (9/12)
UnitedHealthcare
Butrans
- Covered on 4 commercial plans
- PA (4/8) · Step Therapy (0/8) · Qty limit (6/8)
Lyrica
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (4/8)
Humana
Butrans
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (3/3)
Lyrica
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Butrans.
No savings programs available for Lyrica.
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ButransView full Butrans profile
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.