Lyrica for Back Pain

Several years ago my rheumatologist put me on Gabapentin (Neurontin) to help control my RLS. It worked at first however as with all the meds I have taken for RLS, the effectiveness waned over time. I was up to 1.5 grams per night and it wasn’t effective. So a pain management specialist changed me to Lyrica (Pregabalin), taking 150mg in the morning and 300mg at night. Again, it worked at first but then over time lost effectiveness against RLS. I have however continued to take it as psychologically I guess it helps me, and also recently I have more evidence that it is helping with my back pain.

I have typical PsA back pain, i.e. nothing during the day and then it comes on during my sleep, to the point that the back pain is so intense in the morning it wakes me up. Having a stiff back in the morning is one of the diagnostic points of PsA. Anyway I missed a couple of nightly does of Lyrica and found that my back pain got much much worse. I would wake at 3am or 4am from the pain. Sleep deprivation is certainly not good for health. Anyway, I have to remember to take my Lyrica!

I am now working in China, and China always amuses me with its “quirks”. One of the quirks is the approval process for medications. Like any country China has a drug authority which is responsible for approving any medications available for sale and prescribing. However China differs from other countries in that the approval is only given for a dose/type specific medication! What does that mean? Take Lyrica as an example. When Lyrica went through the approval process in China, they used the 75mg capsule. In the West (and in Thailand) the DRUG gets the approval, so after approval is given then any dosage of the drug is now legal, e.g. Lyrica can come in 75mg or 150mg capsules. In China though, only the DOSE or TYPE that went through the approval process, is approved! So since I can take 450mg of Lyrica per day, and only the 75mg capsule is approved in China, I have to take 6 capsules per day! In Thailand, I could get the 150mg capsules and only would need 3 per day. In China the 150mg would have to go through a totally new application in order to become legal, even though it is the exact same drug as the 75mg! Crazy.

In a box, there are only 8 capsules, so I go through just about 1 box per day. When I get 3 months supply of Lyrica, I need about 12 boxes. I have a huge bag I have to take out. It is the same for Leflunomide (Arava). I take 20mg per day and in Thailand they have 20mg pills. In China they only have 10mg. It is even worse for my Enbrel. In Thailand I could get the prefilled syringes – which are soooooo convenient. In China though, the prefilled syringes would have to go through a totally new application (even though the Enbrel is the same), and the supplier just can’t be bothered. So in China only the old style are available and I have to mix the water with the powder then transfer to a syringe etc.

In some areas China are so backward! I have heard that they only approve one type in order to discourage copies, however to my logic if there is only one type of a drug available then any counterfeiters only have one “type” to copy!


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