CABALIN 25MG CAPS 24S

Cabalin (pregabalin 25 mg) is an anticonvulsant and analgesic agent belonging to the gabapentinoid class. 

Pregabalin is approved for: neuropathic pain associated with diabetic peripheral neuropathy (DPN); post-herpetic neuralgia (PHN, the persistent burning pain after shingles); neuropathic pain associated with spinal cord injury; fibromyalgia; and as adjunctive therapy for partial-onset seizures in epilepsy (adults and children from 1 month of age).

Off-label uses include generalised anxiety disorder (approved in the EU), restless legs syndrome, and alcohol withdrawal.

The 75 mg capsule is typically used as a starting or maintenance dose and is adjusted upwards based on clinical response and tolerability. Pregabalin is renally excreted and dose adjustment is required in patients with renal impairment.

Cabalin 75 mg capsules may be taken with or without food. Swallow whole with water. Take at the same time each day for consistent effect.

Neuropathic Pain (Diabetic Peripheral Neuropathy, PHN)

•     Starting dose: 75 mg once daily (150 mg/day).

•     After 1 week: May be increased to 150 mg daily based on efficacy and tolerability.

•     Maximum dose: 300 mg twice daily (600 mg/day) for patients who do not achieve sufficient pain relief at lower doses.

Fibromyalgia

•     Start: 75 mg once daily. Increase to 150 mg once daily within 1 week if tolerated.

•     Maximum: 225 mg twice daily (450 mg/day).

Spinal Cord Injury Neuropathic Pain

•     Start: 75 mg twice daily. Increase to 150 mg twice daily within 1 week.

•     Maximum: 300 mg twice daily (600 mg/day).

Epilepsy (Adjunct for Partial-Onset Seizures)

•     Adults: Start 75 mg twice daily; increase to 150 mg twice daily; maximum 300 mg twice daily (600 mg/day).

Renal Impairment Dose Adjustment

•     CrCl 30–59 mL/min: 75–300 mg/day in 2–3 divided doses.

•     CrCl 15–29 mL/min: 25–150 mg/day in 1–2 divided doses.

•     CrCl <15 mL/min or haemodialysis: 25–75 mg once daily; supplemental dose after each dialysis session.

Side effects vary in frequency and severity. Not every patient will experience all listed effects. Seek immediate medical attention for any serious or unexpected reactions.

•     Respiratory depression: Life-threatening respiratory depression has been reported with gabapentinoids, particularly when combined with opioids, CNS depressants, or in patients with respiratory compromise. Monitor closely.

•     Suicidal ideation: A class-wide warning applies to all anticonvulsants. Monitor for new or worsening depression, anxiety, or suicidal thoughts, especially in the first weeks of treatment.

•     Abrupt withdrawal: Do not stop suddenly after prolonged use. Taper gradually over at least 1 week to avoid withdrawal symptoms (insomnia, nausea, headache, anxiety) and risk of seizure exacerbation.

•     Dizziness and somnolence: Impairs driving ability. Advise patients not to drive until they have established their personal response to pregabalin.

•     Peripheral oedema: Monitor patients with cardiovascular or renal risk factors for oedema and fluid retention.

•     Abuse potential: Although not scheduled as a controlled substance in Kenya, pregabalin has been recognised globally as having significant misuse potential, particularly in combination with opioids or benzodiazepines. Prescribers should be vigilant.

•     Pregnancy: Associated with major congenital malformations in animal studies. Effective contraception required during treatment. Not recommended in pregnancy.

The following interactions are clinically significant. Always inform your healthcare provider of ALL medicines, supplements, and herbal products you are taking.

•     Opioids and CNS depressants (including alcohol): Additive CNS depression and respiratory depression, life-threatening combination.

•     Benzodiazepines: Additive CNS depression; risk of respiratory compromise.

•     Thiazolidinediones (pioglitazone, rosiglitazone): Pregabalin may increase fluid retention and oedema risk.

•     Alcohol: Additive CNS impairment; avoid.

•     Lorazepam or oxycodone: No pharmacokinetic interaction, but additive pharmacodynamic effects on CNS depression.

Store below 30°C. Keep in original packaging. Keep out of reach of children. Protect from moisture.

Cabalin 75 mg (pregabalin) is a POM in Kenya. Although not yet formally scheduled as a controlled substance in Kenya, prescribers and pharmacists should be aware that pregabalin has well-documented misuse potential, particularly in combination with opioids and benzodiazepines. Screen for concurrent CNS depressant prescriptions at point of dispensing. Counsel patients on the risk of respiratory depression in this context. Renal function must be assessed before initiating therapy; dose adjustment is mandatory in renal impairment. Pregabalin must not be stopped abruptly in epilepsy patients, emphasise this at every dispensing encounter.

Q1: What type of pain does pregabalin treat?

A: Pregabalin is specifically effective for neuropathic pain, nerve pain caused by diabetes (burning feet/hands), shingles, spinal cord injury, or fibromyalgia. It is not effective for ordinary tissue or muscle pain (e.g., from a bruise or inflammation).

Q2: How long does it take for pregabalin to relieve nerve pain?

A: Some patients notice improvement within 1–2 weeks, but full therapeutic benefit may take 4–6 weeks. If there is no significant benefit after 8 weeks at the maximum tolerated dose, the medicine should be re-evaluated.

Q3: Will I gain weight on pregabalin?

A: Weight gain is a recognised side effect, related to fluid retention and possible appetite increase. Maintaining a balanced diet and regular activity can help minimise this. Discuss with your doctor if weight gain is significant.

Q4: Can pregabalin be taken with my opioid painkillers?

A: This combination requires very close medical supervision. Both pregabalin and opioids depress the central nervous system and slow breathing. The combination can be life-threatening without careful monitoring. Never start or adjust this combination without your doctor's knowledge.

Q5: Is pregabalin addictive?

A: Pregabalin has recognised misuse and dependence potential, particularly at high doses or in people with a history of substance misuse. Use exactly as prescribed, do not increase the dose without medical advice, and do not stop suddenly.