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Researchers Study Lyrica/Seroquel Combo Therapy

Posted: July 31, 2007

Being able to use one medication to treat fibromyalgia would be ideal but may be unrealistic given the wide range of symptoms most patients experience. "Combination therapy using drugs targeting different symptoms of the disease seems to be worthy of exploration," says Elena P. Calandre, M.D., and her research team in Granada, Spain.1 She took 19 fibromyalgia patients who were already receiving some symptom relief with low-dose Seroquel (25-100 mg per night) and added a small quantity of Lyrica (75-375 mg per day in two divided doses). Seroquel has many modes of action that include boosting serotonin, dopamine, norepinephrine, and histamine (this latter effect produces sleepiness, which is why the drug is taken at night).

In a previous study involving 35 fibromyalgia patients, Calandre found that 25-100 mg per night of Seroquel improved sleep, fatigue, stiffness, anxiety, and mood.2 It also increased the number of days patients "felt good." While the drug was well-tolerated (only five patients dropped out of the three month trial), Seroquel usually did not aid with the symptom of pain. For those patients still needing pain relief, Calandre included Lyrica as an add-on drug for 19 fibromyalgia patients with the goal of reducing pain.

"Lyrica augmentation of Seroquel therapy significantly improved pain and quality of life," writes Calandre. The average dose of Lyrica needed by patients in this combo study was only 200 mg per day (taken as 100 mg capsules twice daily), which is less than half of the amount used in the Lyrica trials to provide effective pain relief.

This study was small and chances are that not all fibromyalgia patients will respond favorably to this combination. In fact, four people dropped out of the combo study because of drug side effects (even at low doses), and all patients were already on a stable dose of Seroquel before entering the study to add on Lyrica. Despite these limitations of the study, the authors suggest the combo of Lyrica plus Seroquel could benefit a subgroup of fibromyalgia patients, with each drug acting to reduce different symptoms in a complementary fashion.

Would the combination of Lyrica/Seroquel work better than either drug alone? Response to medications is hard to predict, but this could represent a good approach for some fibromyalgia patients. The key point of this study is to show that more than one drug may be used strategically in lower-than-normal doses to target your symptoms.

1. Calandre E, et al. Pharmacopsychiatry 40:68-71, 2007.
2. Calandre E, at al. Prog Neuro-Psychopharm & Biol Psych 31:71-7, 2007.

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