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Lyrica vs Wellbutrin
Introduction
In the realm of neuropathic pain or anxiety disorders, certain medications that modify the amounts of neurotransmitters in the brain can assist in managing symptoms and improving a patient's quality of life. Lyrica (pregabalin) and Wellbutrin are two such medications frequently prescribed for these conditions. Both affect different neurotransmitter mechanisms within the brain but share an end goal: to alleviate discomfort and improve functionality. Lyrica is primarily classified as a gabapentinoid, which means it works by binding to calcium channels in nerve cells, reducing neurotransmitter release and subsequently decreasing overactive nerve signalling causing pain or anxiety. On the other hand, Wellbutrin acts as a norepinephrine-dopamine reuptake inhibitor (NDRI), mainly affecting levels of norepinephrine and dopamine to lift mood levels.
Lyrica vs Wellbutrin Side By Side
| Attribute | Lyrica | Wellbutrin |
|---|---|---|
| Brand Name | Lyrica | Wellbutrin |
| Contraindications | Should not be taken with or have recently used opioid medications. | Should not be taken with or have recently used opioid medications. |
| Cost | For brand name: about $470 for 30 capsules of 75 mg. For generic: as low as $.50/day depending on dosage and quantity. | For brand name: about $500 for 60 tablets of 100 mg. For generic: approx. $.25 - $.80 per day at dosages ranging from 150mg –450mg per day. |
| Generic Name | Pregabalin | Bupropion |
| Most Serious Side Effect | Thoughts about suicide or self-harm, signs of an allergic reaction, changes in eyesight, rapid heart rate, low sodium levels, unusual muscle stiffness or twitching, fever coupled with sweating. | Signs of an allergic reaction, an increase in suicidal thoughts or tendencies to self-harm, seizure activity, experiencing confusion and unusual changes in mood or behavior, vision disturbances, rapid heartbeat rate and irregular heartbeats, manifestations suggestive of a manic episode. |
| Severe Drug Interactions | Opioids require a period of approximately one week to clear from your system to prevent dangerous interactions. | Opioids require a period of approximately one week to clear from your system to prevent dangerous interactions. |
| Typical Dose | 150-600 mg/day, divided into two or three doses. | 100–200 mg/day, up to a maximum of 450mg/day divided into three doses. |
What is Lyrica?
Pregabalin (the generic name for Lyrica) is a medication that falls under the class of drugs known as anticonvulsants, which was a significant advancement from first-generation pain relievers. Pregabalin was first approved by the FDA in 2004 and 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 primarily prescribed for conditions such as fibromyalgia, neuropathic pain, and partial onset seizures. Unlike antidepressants like Wellbutrin which primarily affect norepinephrine and dopamine levels, Lyrica's mechanism primarily involves binding to calcium channels on nerve cells, reducing neurotransmitter release and thereby easing painful or seizure-inducing nerve transmissions. This results in it having different side effects than other medications that work differently within our bodies.
What conditions is Lyrica approved to treat?
Lyrica is approved for the treatment of a variety of medical conditions, such as:
- Diabetic peripheral neuropathy (nerve pain caused by diabetes)
- Postherpetic neuralgia (pain following healing of the rash due to shingles)
- Fibromyalgia
- Neuropathic pain associated with spinal cord injury
- Adjunctive therapy for adult patients with partial onset seizures
How does Lyrica help with these illnesses?
Lyrica helps manage neuropathic pain and epilepsy by slowing down impulses in the brain that cause seizures. It does this by binding to a specific site of voltage-gated calcium channels in central nervous system tissues, reducing the release of neurotransmitters such as glutamate, noradrenaline, substance P and calcitonin gene-related peptide. Unlike serotonin which is involved with mood regulation among other things, these neurotransmitters are primarily involved in transmitting pain signals throughout the body and brain. Therefore, Lyrica can help alleviate chronic pain conditions associated with fibromyalgia or diabetic peripheral neuropathy or nerve damage caused by shingles (herpes zoster) infection.
On the other hand, Wellbutrin works by inhibiting reuptake of two major neurotransmitters—dopamine and norepinephrine—in your brain. This inhibition allows more dopamine and norepinephrine to be available for necessary cellular communication within your brain without being quickly absorbed again into cells. Dopamine has several functions including mood regulation while norepinephrine acts on parts of the brain where attention and responding actions are controlled along with epinephrine to increase heart rate & blood pressure giving us energy when we need it during fight-or-flight response situations.
What is Wellbutrin?
Wellbutrin is a brand name for bupropion, which operates as a norepinephrine-dopamine reuptake inhibitor (NDRI). It raises the levels of norepinephrine and dopamine in the brain by reducing their reabsorption. Furthermore, it acts as a mild nicotinic receptor antagonist, blocking the action of acetylcholine at its receptors. The FDA first approved bupropion in 1986. Bupropion differs from SSRI antidepressants like Lyrica because it does not inhibit serotonin's reuptake; this discrepancy leads to differences in side-effect profiles. Notably, Wellbutrin doesn't cause sedation and is less likely to result in weight gain or sexual dysfunction- common side effects among SSRIs such as Lyrica. The influence on dopamine and norepinephrine can be beneficial for treating depression, particularly in patients who don't respond well to traditional SSRI antidepressant medications like Lyrica.
What conditions is Wellbutrin approved to treat?
Wellbutrin, unlike Lyrica which is used for nerve and muscle pain, has been approved by the FDA for the treatment of:
- Major Depressive Disorder (MDD), helping to alleviate symptoms of deep sadness and disinterest.
- Seasonal Affective Disorder (SAD), also termed "winter depression," characterized by feelings of lethargy and moodiness that occur during fall/winter when daylight hours are short.
How does Wellbutrin help with these illnesses?
Dopamine, similar to norepinephrine, is a neurotransmitter that plays vital roles in the brain's reward and pleasure centers. It also helps regulate emotional responses and movement. Low levels of dopamine have been associated with depression as well as other disorders like Parkinson's disease. Wellbutrin acts by increasing the levels of dopamine available in your brain, thereby easing some depressive symptoms. Its effects on norepinephrine and acetylcholine may also contribute to its action as an antidepressant medication. Unlike Lyrica which primarily targets nerve pain or seizures due to its function in calming overactive neurons, Wellbutrin does not significantly affect GABA (a major inhibitory neurotransmitter) levels; instead it enhances mood regulation without sedative side-effects. Therefore, it can be prescribed when a patient doesn’t respond favorably to typical SSRI antidepressants or combined with these drugs if needed.
How effective are both Lyrica and Wellbutrin?
Both pregabalin (Lyrica) and bupropion (Wellbutrin) are well-established medications, initially approved by the FDA in 2004 and 1985 respectively. Pregabalin is primarily used for neuropathic pain, fibromyalgia, and generalized anxiety disorder while bupropion is an antidepressant used to treat major depressive disorder and seasonal affective disorder. The two drugs act on different neurotransmitters: pregabalin works by binding to calcium channels to decrease the release of neurotransmitters like glutamate, norepinephrine, substance P, and calcitonin gene-related peptide; bupropion acts as a norepinephrine-dopamine reuptake inhibitor.
A meta-analysis from 2013 found that patients suffering from fibromyalgia who were treated with pregabalin experienced significant improvements in their condition compared to placebo treatment. In addition to its efficacy at relieving symptoms associated with fibromyalgia and nerve pain related to diabetes or shingles infection, some studies have shown that it helps manage symptoms of withdrawal from other substances such as alcohol.
Bupropion’s effectiveness at treating depression was directly studied in several double-blind clinical trials over the years. A review published in The Cochrane Library indicated that bupropion seems more effective than placebo for treating depression but possibly less effective than other popular antidepressants when comparing remission rates. Nonetheless, due to its unique pharmacology -- specifically its lack of sexual side effects -- Wellbutrin may be an optimal choice for individuals who didn't respond well on SSRIs or SNRIs or those wishing avoid common side effects often seen with these types of antidepressants.
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At what dose is Lyrica typically prescribed?
Oral dosages of Lyrica range from 150-600 mg/day, divided into two or three doses. For neuropathic pain associated with diabetic peripheral neuropathy, the starting dosage is 50 mg taken three times a day (150 mg/day). The dosage may be increased to a maximum of 300 mg per day after one week if their response is insufficient. For patients with fibromyalgia, the recommended starting dose is 75mg twice daily which could be increased to maximum dose of 450mg/day based on individual patient response and tolerability. In all cases, it's important that this medication isn't discontinued abruptly due to risk of increasing seizure frequency in patients with seizure disorders.
At what dose is Wellbutrin typically prescribed?
Wellbutrin treatment for depression typically begins at a dosage of 100–200 mg/day. If necessary, the dose can be increased to 300 mg/day, split into two doses that are taken approximately eight hours apart. Should there be no response to this regimen after several weeks, your physician may consider increasing the daily dosage up to a maximum of 450mg. This would then be divided into three separate doses of 150 mg each and spaced six hours apart throughout the day. As always remember that it's crucial not to adjust dosages or medication schedules without consulting with your healthcare provider first.
What are the most common side effects for Lyrica?
Common side effects of Lyrica can include:
- Drowsiness or somnolence
- Dizziness
- Dry mouth
- Edema (swelling)
- Blurred vision
- Weight gain and increased appetite
- Trouble concentrating
- Feeling "high"
- Constipation
On the other hand, Wellbutrin's common side effects are slightly different. These may include:
- Dry mouth
- Nausea/vomiting
- Stomach/abdominal pain
- Constipation
- Trouble sleeping (insomnia)
- Increased sweating or urination,
- Sudden changes in weight.
Remember to consult with a healthcare professional for advice on medication and potential side-effects.
Are there any potential serious side effects for Lyrica?
While comparing Lyrica with Wellbutrin, it's important to understand that both deal with neurological issues but have different side effects. For Lyrica, these may include:
- Thoughts about suicide or self-harm
- Signs of an allergic reaction: hives, difficulty breathing, swelling in your face or throat
- Changes in eyesight including blurred vision and seeing halos around lights
- Rapid heart rate, palpitations or chest discomfort
- Low sodium levels - symptoms can be headache, confusion, slurred speech, severe weakness, vomiting and unsteadiness
- Unusual muscle stiffness or twitching
- Fever coupled with sweating
On the other hand dystonia (abnormal muscle contractions), seizures and hallucinations are more common in patients using Wellbutrin. If you experience any of these symptoms while on either medication please seek immediate medical attention.
What are the most common side effects for Wellbutrin?
For Wellbutrin, potential side effects can include:
- Dry mouth
- Sore throat
- Nausea, vomiting, stomach pain
- Loss of appetite leading to weight loss
- Insomnia or other sleep problems
- Sweating and increased urination
- Shaking (tremor) or anxiety
- Faster heartbeat than normal
- Ringing in your ears (tinnitus)
- Severe headache, blurred vision
- Skin rashes
Muscle or joint aches. It's important to note that while these are potential side effects, not all individuals taking Wellbutrin will experience them and they may lessen over time as the body adjusts to the medication. Always consult with your healthcare provider for any concerns regarding medication side effects.
Are there any potential serious side effects for Wellbutrin?
As with any medication, Wellbutrin can come with its own potential side effects. These could include:
- Signs of an allergic reaction, including skin hives and itching, fever or swollen glands, difficulty breathing or swelling in the face or throat
- An increase in suicidal thoughts or tendencies to self-harm
- Seizure activity (convulsions)
- Experiencing confusion and unusual changes in mood or behavior
- Vision disturbances such as blurred vision, tunnel vision, eye pain/swelling or experiencing halos around lights
- Rapid heartbeat rate and irregular heartbeats
- Manifestations suggestive of a manic episode which may include racing thoughts, increased energy levels leading to reckless behavior; feelings of extreme happiness or irritability; talkativeness beyond usual habits; severe problems associated with sleep.
If you notice any of these symptoms while on Wellbutrin it is essential that you consult your doctor immediately.
Contraindications for Lyrica and Wellbutrin?
Both Lyrica and Wellbutrin, along with most other medications for nerve pain or depression, may intensify symptoms in some people. If you notice your condition worsening, such as increased pain or the onset of depressive thoughts, please seek immediate medical attention.
Neither Lyrica nor Wellbutrin should be taken if you are using or have recently used opioid medications. Always inform your physician about all the medications that you are taking; opioids will require a period of approximately one week to clear from your system to prevent dangerous interactions with both Lyrica and Wellbutrin.
How much do Lyrica and Wellbutrin cost?
For the brand name versions of these drugs:
- The price for 60 tablets of Wellbutrin SR (100 mg) averages around $500, which works out to approximately $16–32/day, depending on your dose.
- In comparison, the price for 30 capsules of Lyrica (75 mg) is about $470. This translates to roughly $15–$31 per day based on a typical dosage of up to 600mg per day.
Thus, if you are in the higher dosage range for Wellbutrin (i.e., 300 mg/day or higher), then brand-name Lyrica may be less expensive on a per-day treatment basis. However, it's important to note that cost should not be a primary consideration in determining which drug is right for you.
For generic versions – Pregabalin (Lyrica) and Bupropion HCL XL (Wellbutrin):
-
Generic Bupropion HCL XL is available in packs starting from 30 tablets and above; costs can range anywhere between approx. $.25 - $.80 per day at dosages ranging from 150mg –450mg per day.
-
Pregabalin comes in packets containing between 10 and several hundred capsules with concentrations varying from as low as $.50/day upwards depending on various factors such as capsule strength and quantity bought at once.
Popularity of Lyrica and Wellbutrin
Pregabalin, available under the brand name Lyrica among others, is used to treat epilepsy, neuropathic pain, fibromyalgia, and generalized anxiety disorder. It was estimated that in 2020 about 6 million people were prescribed pregabalin in the US. Pregabalin accounted for roughly 15% of all prescriptions for nerve pain treatment medications and just over 10% of overall anticonvulsant prescriptions.
Bupropion on the other hand, which comes as both a generic form and also under brand names such as Wellbutrin among others, was prescribed to approximately 5.8 million people in the USA during the same year. Bupropion makes up slightly more than 12% of antidepressant prescriptions across America making it one of the most common "atypical" antidepressants (not classified as an SSRI or another broad class of antidepressants). The use of bupropion has been generally increasing since its approval by FDA back in 1985.
Conclusion
Both Lyrica (pregabalin) and Wellbutrin (bupropion) have extensive records of usage in patients with different medical conditions, and are supported by numerous clinical studies indicating that they are more effective than placebo treatments. They may sometimes be used together for certain conditions like fibromyalgia or neuropathic pain accompanied by depression but this should be under the strict guidance of a physician as their interaction can cause side effects such as dizziness, confusion, and difficulty concentrating. Due to their diverse mechanisms of action—with Lyrica primarily acting on calcium channels to decrease release of pain signals, while Wellbutrin acts mainly on norepinephrine and dopamine—they are usually prescribed under distinctive circumstances.
Lyrica is often the first-line treatment option for nerve pain associated with diseases like fibromyalgia or diabetic peripheral neuropathy, whereas Wellbutrin is frequently considered an initial choice for major depressive disorder or help to quit smoking.
Both drugs have generic versions available which represent significant cost savings especially for patients who must pay out-of-pocket expenses. Both Lyrica and Wellbutrin may require an adjustment period, meaning that full beneficial effects might not be noticeable immediately.
The side effect profile varies between these two medications. Both are generally well-tolerated; however, common side effects of Lyrica include drowsiness and weight gain unlike Wellbutrin which can cause insomnia but less likely result in weight gain. As always with these medications, patients need to closely monitor their condition especially when initiating therapy or changing dosage levels.
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Refrences
- Sicras-Mainar, A., Rejas-Gutiérrez, J., Pérez-Paramo, M., Sánchez-Alvarez, L., Navarro-Artieda, R., & Darbà, J. (2018, September 17). Consequences on economic outcomes of generic versus brand-name drugs used in routine clinical practice: the case of treating peripheral neuropathic pain or generalized anxiety disorder with pregabalin. Expert Review of Pharmacoeconomics & Outcomes Research. Informa UK Limited.http://doi.org/10.1080/14737167.2019.1519399
- Senderovich, H., & Jeyapragasan, G. (2017, December 4). Is there a role for combined use of gabapentin and pregabalin in pain control? Too good to be true?. Current Medical Research and Opinion. Informa UK Limited.http://doi.org/10.1080/03007995.2017.1391756
- Taylor, C. P., Angelotti, T., & Fauman, E. (2007, February). Pharmacology and mechanism of action of pregabalin: The calcium channel α2–δ (alpha2–delta) subunit as a target for antiepileptic drug discovery. Epilepsy Research. Elsevier BV.http://doi.org/10.1016/j.eplepsyres.2006.09.008
- Stahl, S. M., Pradko, J., Haight, B. R., Modell, J. G., Rockett, C. B., & Learned-Coughlin, S. (2004, August 13). A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor. The Primary Care Companion For CNS Disorders. Physicians Postgraduate Press, Inc.http://doi.org/10.4088/pcc.v06n0403