Alpha₂delta ligands, gabapentin, pregabalin and mirogabalin: a review of their clinical pharmacology and therapeutic use

ABSTRACT

Introduction: The first two alpha₂delta ligands – gabapentin (GBP) and pregabalin (PGB) – were initially synthesized as antiepileptics; however, they were later also found to be useful for the treatment of additional conditions.

Areas covered: Relevant publications describing potential underlying mechanisms, clinical pharmacokinetics/pharmacokinetics, and clinical efficacy and safety of these drugs in various disease conditions were searched in PubMed and Scopus and included in this review.

Expert commentary: GBP and PGB are effective for the treatment neuropathic pain, fibromyalgia and epilepsy; in addition, they may be useful for the reduction of postoperative pain. PGB is also effective for the treatment of generalized anxiety disorder and GBP for the treatment of restless legs syndrome. GBP may be considered a treatment option for pain associated with Guillain-Barré Syndrome and phantom limb and for the management of uremic pruritus. Mirogabalin (MGB), recently developed, is being investigated for the treatment of peripheral neuropathic pain and fibromyalgia, showing promising results in patients with diabetic peripheral neuropathy. Their most frequent adverse reactions are of neuropsychiatric nature and include fatigue, dizziness, sedation, somnolence, and ataxia; peripheral edema and weight gain are also frequently described. Pharmacokinetic interactions are scarce; however, pharmacodynamic interactions have been described in association with drugs with CNS-depressant effects.

KEYWORDS:

• Gabapentin
• pregabalin
• mirogabalin
• alpha₂delta ligands
• mechanism of action
• pharmacokinetics
• drug interactions
• adverse reactions
• clinical indications

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Declaration of interest

E.P Calandre is principle investigator in the European mirogablin clinical trials DS5565-A-E310 and DS-5565-A-E312 concerning the short and long term efficacy of the drugs in the treatment of fibromyalgia. F. Rico-Villademoros has received honoraria for consultancy, providing educational sessions, and/or providing medical writing services for Eli Lily, Janssen, Lundbeck, and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.