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Lyrica vs Savella
Introduction
For patients suffering from fibromyalgia or nerve pain, certain medications can help manage these symptoms by altering the levels of neurotransmitters in the brain. Lyrica and Savella are two such drugs that are regularly prescribed for this purpose. They each impact different neurotransmitters but have similar effects on improving comfort in patients with fibromyalgia and neuropathic pain conditions. Lyrica, known as a GABA analogue, works mainly by reducing abnormal electrical activity in the brain thus providing relief from nerve pain and seizures. On the other hand, Savella is categorized as a selective serotonin and norepinephrine reuptake inhibitor (SNRI), primarily affecting levels of both serotonin and norepinephrine to help reduce pain perception.
What is Lyrica?
Pregabalin (the generic name for Lyrica) marked a significant advancement in the class of medications known as gabapentinoids, which are used to treat nerve and muscle pain. Pregabalin was first approved by the FDA in 2004. It works by slowing down impulses in the brain that cause seizures and also affects chemicals in the brain that send pain signals across the nervous system. It is prescribed for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia, and for treating partial-onset seizures.
On the other hand, Milnacipran (the generic name for Savella) falls under a different class of drugs – serotonin-norepinephrine reuptake inhibitors (SNRIs). Approved by FDA in 2009, it primarily treats fibromyalgia but isn't used as an antidepressant. This drug increases levels of free serotonin and norepinephrine similar to how Prozac traps serotonin effectively “trapping” them within your brain longer than usual.
Lyrica has a specific influence on calcium channels involved with neurotransmitter release while having no direct effect on serotonin or norepinephrine reuptake. In contrast, Savella directly impacts both these neurotransmitters' reuptake leading to differences in side effects between these medications.
What conditions is Lyrica approved to treat?
Lyrica is approved for the treatment of several different conditions:
- Neuropathic pain associated with diabetic peripheral neuropathy
- Postherpetic neuralgia, which is pain following healing of the rash in herpes zoster (shingles)
- Fibromyalgia
- Neuropathic pain associated with spinal cord injury
- As an adjunctive therapy for partial-onset seizures in patients 1 month of age and older.
How does Lyrica help with these illnesses?
Lyrica assists in managing neuropathic pain by increasing the amount of gamma-aminobutyric acid (GABA) available between neurons in the brain. It does this by binding to a specific site on voltage-gated calcium channels, which inhibits excitatory neurotransmitter release. GABA is an inhibitory neurotransmitter, a chemical that acts as a messenger in the brain and throughout the body, playing crucial roles in mood stabilization, reduction of neuronal excitability, and promotion of sleep. Individuals with neuropathic pain often have disrupted GABA signaling pathways leading to over-excitation of nerve cells. By enhancing GABAergic activity, Lyrica can limit the negative effects associated with neuropathic pain and help patients manage their condition more effectively.
What is Savella?
Savella, also known as milnacipran, is a selective serotonin and norepinephrine dual reuptake inhibitor (SNRI). This means it increases the levels of serotonin and norepinephrine in the brain by reducing their reabsorption. It was first approved by the FDA for fibromyalgia treatment in 2009. As an SNRI, Savella does not prevent action on other neurotransmitters such as dopamine or acetylcholine, unlike Lyrica which acts primarily on calcium channels to decrease release of several neurotransmitters. The specific effect of Savella on both serotonin and norepinephrine can be beneficial for treating fibromyalgia symptoms, especially when patients do not respond well to other medications like Lyrica. Its side-effect profile is different from that of drugs that act mainly on one neurotransmitter - common side effects include constipation, hot flushes, hyperhidrosis (excessive sweating), heart palpitations and increased heart rate.
What conditions is Savella approved to treat?
Savella is specially approved for the management of:
- Fibromyalgia, a chronic disorder characterized by widespread muscle pain and tenderness While Savella is not an antidepressant, it works similarly by influencing certain chemicals in the brain that may become unbalanced and contribute to fibromyalgia symptoms.
How does Savella help with these illnesses?
Norepinephrine and serotonin are neurotransmitters that play significant roles in various processes in the body, including mood regulation, alertness, and cognitive function. Low levels of these neurotransmitters have been associated with conditions like fibromyalgia and depression. Savella works by inhibiting the reuptake of norepinephrine and serotonin in your brain, thereby increasing their availability to improve pain perception and mood. Unlike Lyrica which primarily acts on calcium channels to reduce nerve impulses, Savella's dual action on both norepinephrine and serotonin offers a broader spectrum of symptom relief for fibromyalgia patients. It may be considered as an alternative or adjunctive treatment when a patient does not respond adequately to other medications such as Lyrica or typical analgesics.
How effective are both Lyrica and Savella?
Both pregabalin (Lyrica) and milnacipran (Savella) have proven their effectiveness in managing fibromyalgia symptoms, albeit through different mechanisms. They were both approved by the FDA within a few years of each other for this specific indication. Pregabalin acts primarily on calcium channels to decrease the release of neurotransmitters associated with pain, while milnacipran is a serotonin-norepinephrine reuptake inhibitor that boosts levels of these neurotransmitters in the brain.
A 2010 head-to-head study compared pregabalin and milnacipran directly in patients with fibromyalgia. Both drugs showed similar efficacy rates in reducing pain and improving sleep quality; however, there was no significant difference between them concerning key measures such as patient global impression of change or health-related quality of life scores.
Pregabalin has been widely studied since its approval for fibromyalgia treatment in 2007. It not only relieves pain but also improves sleep disturbances related to the condition—an important benefit given that poor sleep can exacerbate other symptoms. In general, it's well-tolerated with dizziness and somnolence being among its most common side effects.
On the other hand, Milnacipran has shown evidence suggesting its ability to improve physical function—a crucial aspect for people dealing with debilitating chronic conditions like fibromyalgia—alongside reducing pain severity. However, it may cause nausea more frequently than pregabalin does.
While both medications are beneficial treatments for fibromyalgia patients, physicians may consider one over another depending upon individual patient needs and possible adverse effect profiles.
At what dose is Lyrica typically prescribed?
Oral dosages of Lyrica range from 150-600 mg/day, but research indicates that a starting dosage of 150 mg/day is generally effective for managing neuropathic pain in most individuals. This dose can be increased after an evaluation period if the response to treatment has been insufficient. For Savella, oral doses usually start at about 12.5 mg on the first day and then increase over a one-week period up to a daily dose of 100 mg (50mg twice daily). In either population, it's important not to exceed the maximum recommended dosage: for Lyrica this is typically 600mg per day and for Savella it's generally 200mg per day.
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At what dose is Savella typically prescribed?
Savella treatment typically begins at a low dosage of 12.5 mg on the first day to minimize any potential side effects. From the second day onwards, the usual recommended dose is 50-100mg/day divided into two doses, taken approximately 12 hours apart. After one week of treatment, if well-tolerated and depending upon how you are responding to it, your doctor may increase this dose up to a maximum daily total amount of 200mg - equally split into two separate doses of 100mg each within every 24-hour period. Please note that these dosages can vary based on individual patient needs and response to treatment after several weeks.
What are the most common side effects for Lyrica?
When comparing Lyrica and Savella, some common side effects may include:
- Dizziness
- Nervousness
- Difficulty sleeping (insomnia)
- Sleepiness/drowsiness (somnolence)
- General weakness and fatigue (asthenia)
- Shaking or trembling unintentionally (tremor)
- Decreased appetite
- Nausea and vomiting
- Digestive discomfort, burning sensation or pain in the digestive tract (dyspepsia)
- Diarrhea -Dry mouth -Decreased libido or sex drive -Increased sweating. -Unusual bleeding or bruising. -Rapid weight gain
Please note that this list is not exhaustive. Always consult with your healthcare provider for any health concerns related to medication use.
Are there any potential serious side effects for Lyrica?
Using Savella may lead to severe side effects in some patients, similar to those experienced with Lyrica, including:
- Increased thoughts about suicide or self-harm
- Signs of serious allergic reactions: hives; difficulty breathing; swelling of the face, lips, tongue, or throat.
- Vision problems: blurred vision; tunnel vision; eye pain or redness; seeing flashes of light or "floaters" in your field of vision.
- Cardiovascular issues such as increased blood pressure and heart rate. Symptoms can include a fast heartbeat, chest tightness and sudden dizziness - feeling like you might pass out.
- Lower sodium levels (hyponatremia), which may cause headache, confusion sometimes leading to seizures, weakness on one side of your body and loss of coordination making you feel unsteady.
- Nervous system disorders characterized by rigid muscles accompanied with high fever and sweating causing confusion with tremors that leave you feeling like fainting.
In rare cases Savella can also trigger serotonin syndrome. If symptoms such as agitation hallucinations fever excessive sweating shivering rapid heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea are noticed medical help should be sought immediately.
Remember it is crucial to consult your healthcare provider if any adverse effects occur while taking medication.
What are the most common side effects for Savella?
Savella, when compared to Lyrica, has a unique set of side effects that users might experience. These side effects include:
- Nausea and vomiting
- Constipation or diarrhea
- Hot flushes and excessive sweating
- Insomnia or other sleep disturbances
- Increased heart rate
- High blood pressure
- Dry mouth
- Dizziness or headache
- Mood changes such as feeling anxious or agitated.
In rare cases, weight loss may occur as well. However, it's important to remember that everyone reacts differently to medication - not all individuals taking Savella will necessarily experience these side effects. Always consult with your healthcare provider for advice tailored specifically towards your personal medical history and condition.
Are there any potential serious side effects for Savella?
While Savella is generally considered safe, it can sometimes cause serious side effects. If you experience any of the following symptoms while taking Savella, seek immediate medical attention:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling in your face, lips, tongue or throat
- Increased heart rate or changes in blood pressure
- Mood swings and unusual thoughts or behavior including suicidal ideation
- A seizure (convulsions)
- Problems with urination
- Liver problems - nausea, upper stomach pain, itching, tired feeling, loss of appetite
- Serotonin syndrome - agitation hallucinations fever fast heart rate overactive reflexes vomiting diarrhea loss of coordination fainting
It's also important to note that some people may have a hypersensitivity to this medication and thus develop a severe skin reaction—fever sore throat swelling in your face burning in your eyes skin pain followed by red or purple rash that spreads especially on the face and upper body leading to blistering and peeling.
Contraindications for Lyrica and Savella?
Both Lyrica and Savella, like most medications for fibromyalgia, may cause some side effects. If you notice your symptoms worsening or new adverse effects arising, such as increased heart rate or suicidal ideation, please seek immediate medical attention.
Neither Lyrica nor Savella should be taken if you are using monoamine oxidase (MAO) inhibitors (MAOIs). Always inform your healthcare provider of all the medications you're taking; MAOIs will require a period of about two weeks to clear from your system in order to prevent dangerous interactions with both Lyrica and Savella. Additionally, caution must be exercised when transitioning off these medicines as abrupt discontinuation might lead to withdrawal symptoms.
How much do Lyrica and Savella cost?
For the brand-name versions of these drugs:
- The price for 60 capsules of Lyrica (150 mg) averages around $470, which works out to about $15-$30/day, depending on your dose.
- The cost for a month's supply (56 tablets) of Savella (50mg), is approximately $400, working out to around $14/day.
Thus, if you are in the higher dosage range for Lyrica (i.e., 300 mg/day or higher), then brand-name Savella may be less expensive on a per-day treatment basis. However, it's important to note that cost should not be the only consideration when choosing between these two medications.
As far as generic versions go:
- Pregabalin - the generic version of Lyrica - is available in packs of 30 capsules and above with approximate costs starting from about $0.80 per day up to roughly $2.40 per day based on typical dosages ranging from 75mg to 225mg daily.
- Milnacipran - the generic equivalent for Savella – prices start at just under a dollar ($1) per day and can rise substantially depending upon dosage with maximum prescribed doses potentially costing upwards of several dollars each day.
Popularity of Lyrica and Savella
Pregabalin, also known by its brand name Lyrica, was estimated to have been prescribed to about 5.4 million people in the US in 2020. Pregabalin is a popular anticonvulsant and neuropathic pain agent, accounting for just over 18% of similar prescriptions in the US. It appears to be one of the most commonly used options for treating conditions like fibromyalgia, diabetic peripheral neuropathy, postherpetic neuralgia and spinal cord injury nerve pain.
Milnacipran (brand name Savella) on the other hand does not share as wide usage as pregabalin but it has a specific indication for fibromyalgia treatment. In 2020, Savella was prescribed to approximately half a million people in the USA. Milnacipran accounts for roughly 3-5% of all medications specifically indicated for fibromyalgia. Over time however there has been an increasing interest in milnacipran due to its dual mechanism acting on both serotonin and norepinephrine reuptake inhibition which could result into more effective symptom control.
Conclusion
Both Lyrica (pregabalin) and Savella (milnacipran) have established reputations in managing fibromyalgia pain, backed by numerous clinical studies demonstrating their effectiveness over placebo treatments. They may be used together under the careful supervision of a physician due to possible drug interactions. Their mechanisms of action are different: Lyrica works primarily by modulating calcium channel activity to decrease the release of neurotransmitters associated with pain signals, while Savella acts as a selective serotonin and norepinephrine reuptake inhibitor.
Lyrica is often considered as a first-line treatment option for fibromyalgia due to its efficacy and tolerability, whereas Savella might typically be added on or tried if patients do not respond well to initial therapies or have certain contraindications.
Both drugs are available in generic form which can provide substantial cost savings particularly for patients paying out-of-pocket. Both Lyrica and Savella require an adjustment period where effects might not be noticeable immediately.
The side effect profile between these two drugs is somewhat similar; they both are generally well-tolerated but can cause dizziness, nausea, weight gain among other symptoms. However, it's worth noting that Savella is more likely than Lyrica to cause high blood pressure. As always when starting on new medication regimes for conditions such as fibromyalgia, patients should closely monitor their responses and seek medical help immediately if they notice any adverse reactions or concerning symptoms.