Numira 5

Indications

• Numira is prescribed for managing:
  • Neuropathic pain
  • Diabetic peripheral neuropathic pain (DPNP)
  • Postherpetic neuralgia (PHN)
  • Peripheral neuropathic pain (PNP)

Pharmacology

• Mirogabalin, a gamma amino acid derivative, selectively binds to α2δ subunits of voltage-gated calcium channels (VGCCs). This interaction inhibits calcium influx and neurotransmitter release, thereby reducing the excitability of central nervous system neurons. Mirogabalin is rapidly absorbed with peak plasma concentration achieved within 0.5-1.5 hours, and it is primarily excreted unchanged through the kidneys.

Dosage & Administration

• Adults: Start with 5 mg twice daily, increasing to 10 mg twice daily as needed. Adjust between 10 mg and 15 mg twice daily based on symptoms.
• Children & Adolescents: Safety and efficacy are not established; not recommended.
• Hepatic Impairment: Use cautiously in mild to moderate cases. No data for severe impairment.
• Renal Impairment: Adjust doses based on severity, starting from 2.5 mg once or twice daily and adjusting as necessary.

Interactions

• Medication Interactions: Concomitant use with cimetidine or probenecid may increase plasma concentration. Combining with lorazepam can enhance CNS depressive effects. Caution is advised with OAT1, OAT3, OCT2, MATE1, MATE2-K, and UGT inhibitors.
• Food & Alcohol: Food does not affect absorption. Avoid alcohol due to increased sedative effects.

Contraindications

• Contraindicated in patients with hypersensitivity to Mirogabalin and those with mild to moderate hepatic or renal impairment.

Side Effects

• Common: Somnolence, dizziness, edema, and weight gain.
• Rare: Lightheadedness, unconsciousness, liver dysfunction symptoms like jaundice.

Pregnancy & Lactation

• Use during pregnancy only if benefits outweigh risks. Transfer to milk has been reported in animal studies; caution advised during breastfeeding.

Precautions & Warnings

• May cause dizziness, somnolence, or blurred vision. Avoid operating machinery. Elderly patients should be cautious of falls and fractures. Consult a doctor before combining with other medications.

Therapeutic Class

• Adjunct and primary anti-epileptic drugs.

Storage Conditions

• Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.