Both gabapentin (marketed as Neurontin) and pregabalin (sold as Lyrica) are used to help control partial seizures when treating epilepsy and for treating post-herpetic pain from shingles. While both have been proven effective in their intended purposes, there is some debate as to which medication is the better option.
Lyrica (pregabalin) and gabapentin have similar properties and chemical structures (pregabalin is a structural cogener of gabapentin), both medications are classified as anticonvulsants with the chemical classification gamma amino butyric acid, and both are effective in relieving post-herpetic neuralgia. However, pregabalin (currently only available under the brand name Lyrica) is significantly more expensive than gabapentin (in either its generic form or under the brand name Neurontin), with the per dose costs of Lyrica being fifty times higher (or more).
Can Prices Be Deceiving?
But does cost alone make gabapentin a more desirable choice? When comparing pregabalin to gabapentin some interesting patterns and traits emerge.
First, of the two, only Lyrica has FDA approval for the treatment of post-herpetic neuralgia and diabetic peripheral neuropathy, giving it a wider range of application. In addition, Lyrica has shown itself to be the more effective antiepileptic because there has been a reduction in the frequency of seizures in patients who were prescribed this medication. Side effects for both medications are the same, with dizziness and extreme drowsiness being the most common.
Second, gabapentin is absorbed much more slowly than Lyrica is, so it takes longer to realize its full effects (sometimes two to four times longer). Also, the bioavailability of gabapentin (the amount of the medication that is actually absorbed and used by the body) is less than that of pregabalin.
There are two issues associated with this:
- Only 60 percent of a dose of gabapentin is absorbed, while almost 90 percent of Lyrica is absorbed.
- The bioavailability of gabapentin does not increase proportionally as the dosage increases; in fact, it is the reverse - the absorption rate decreases as the dosage increases. The bioavailability of Lyrica holds steady at 90 percent, regardless of dosage.
Lyrica performs as well as gabapentin but at lower dosage amounts, and its effects last longer, which may help with controlling costs, as fewer and smaller doses may be needed.
Combatting Hidden Costs
Finally, those who were prescribed Lyrica instead of gabapentin saw a reduction in associated medical costs. There were fewer special visits to the doctor; and fewer tests and other procedures and services were required.
When all the costs associated with treating post-herpetic pain or epileptic seizures (the shared area of treatment for the two medications) are added up, those associated with Lyrica was slightly less than those for gabapentin. That, along with faster absorption and better performance characteristics, may actually make Lyrica’s total cost more economically viable than gabapentin. So, when it comes down to it, is Lyrica worth the cost? Many would argue, yes.