| chronic pain (diagnosis)
Lyrica vs Nucynta ER
Side-by-side clinical, coverage, and cost comparison for chronic pain (diagnosis).Deep comparison between: Lyrica vs Nucynta 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 signalsNucynta has a higher rate of injection site reactions vs Lyrica based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Nucynta but not Lyrica, including UnitedHealthcare
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Category
Lyrica
Nucynta
At A Glance
Oral
2-3 times daily
alpha2-delta calcium channel ligand
Oral
Twice daily
Opioid agonist / NRI
Indications
- Peripheral Nervous System Diseases
- Epilepsy
- Fibromyalgia
- chronic pain (diagnosis)
- chronic pain (diagnosis)
- Diabetic peripheral neuropathy
Dosing
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.
chronic pain (diagnosis), Diabetic peripheral neuropathy Initiate at 50 mg orally every 12 hours in opioid-naive patients; titrate by 50 mg increments no more than twice daily every three days; maximum total daily dose 500 mg.
Moderate hepatic impairment Initiate at 50 mg no more than once every 24 hours; maximum 100 mg per day; regularly evaluate for respiratory and CNS depression.
Contraindications
- Known hypersensitivity to pregabalin or any of its components
- Significant respiratory depression
- Acute or severe bronchial asthma or hypercarbia in an unmonitored setting or in the absence of resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus
- Hypersensitivity to tapentadol or any other ingredient of the product
- Concurrent use of MAOIs or use within the last 14 days
Adverse Reactions
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
Most common (>=10%) Nausea, constipation, dizziness, headache, somnolence, vomiting
Serious Respiratory depression, serotonin syndrome, adrenal insufficiency, severe hypotension, seizures, neonatal opioid withdrawal syndrome
Postmarketing Hallucination, suicidal ideation, panic attack, anaphylaxis, androgen deficiency, hyperalgesia, allodynia, hypoglycemia, opioid-induced esophageal dysfunction
Pharmacology
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.
Tapentadol is a centrally-acting synthetic analgesic that acts as a mu-opioid receptor (MOR) agonist and norepinephrine reuptake inhibitor (NRI); analgesia in animal models is derived from both properties, though the exact mechanism in humans is unknown.
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Most Common Insurance
Anthem BCBS
Lyrica
- Covered on 5 commercial plans
- PA (0/12) · Step Therapy (0/12) · Qty limit (9/12)
Nucynta
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (9/12)
UnitedHealthcare
Lyrica
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (4/8)
Nucynta
- Covered on 4 commercial plans
- PA (7/8) · Step Therapy (6/8) · Qty limit (7/8)
Humana
Lyrica
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (3/3)
Nucynta
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (3/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Lyrica.
No savings programs available for Nucynta.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.