Intended for healthcare professionals

Letters Pfizer and pregabalin

Pregabalin is only partially effective for neuropathic pain

BMJ 2015; 350 doi: (Published 30 June 2015) Cite this as: BMJ 2015;350:h3478
  1. Jennie Gwynn, retired research and development pharmaceutical executive, patient1
  1. 1Penzance TR20 9PR, UK
  1. jenniegwynn{at}

As a patient with knowledge about research and development (R&D), and marketing, receipt of a prescription for generic pregabalin for neuropathic pain prompted a call to my GP about a possible error. Initially she blamed the pharmacist but the prescription did not specify indication. Subsequent prescriptions have been for Lyrica.

Professionally I am fully aware of escalating R&D costs and maximising patent life.1 However, as a patient, pregabalin is only partially effective in dulling neuropathic pain, with dose dependent debilitating side effects; albeit better than gabapentin. The problem is the lack of effective drugs for neuropathic pain.

Pfizer also uses a flat pricing structure. Trying to save NHS money, I avoid one capsule three times a day and take one twice a day, saving 30%.

I believe there are now fewer different capsule concentrations, making it harder to optimise doses and reduce side effects, especially when concomitant drugs kick in temporarily.

Pfizer’s income from Lyrica for neuropathic pain is increasing, partly because of improved diagnosis and life expectancy, increased symptoms related to spondylitis, and more operations that can damage nerves.

Is Pfizer reinvesting any of these “unexpected” profits in researching more effective drugs for neuropathic pain? If so, apologies might be accepted by all. If not, maybe Pfizer should review its pricing strategy for an already expensive drug used chronically and invest less in its legal battles to lengthen this patent.

Lyrica was Pfizer’s highest generator of income/profit in 2014, with growth in developed countries for neuropathic pain.2 Investment in a sustained release product may be useful to patients and patent life, but would depend on trial outcome and pricing.

Finally, shareholders should understand their profits will never return to the levels of three decades ago and will probably drop further, especially with expensive “niche” drugs dominating R&D.


Cite this as: BMJ 2015;351:h3478



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