Indications

Magolin (Mirogabalin) is indicated for the treatment of neuropathic pain, including:

• Diabetic peripheral neuropathic pain (DPNP)
• Postherpetic neuralgia (PHN)
• Peripheral neuropathic pain (PNP)

Pharmacology

Mirogabalin is a gamma amino acid derivative that acts as a selective inhibitor of the α2δ subunits of voltage-gated calcium channels (VGCCs). By binding to these channels, it reduces calcium influx and neurotransmitter release at presynaptic neuron endings. This action decreases the hyperexcitability of central nervous system (CNS) neurons, thereby reducing pain signals. The drug is rapidly absorbed orally, has low plasma protein binding, and is primarily eliminated unchanged through renal excretion.

Dosage & Administration

• Adults: The initial dose is 5 mg twice daily. The dose is then gradually increased by 5 mg at weekly intervals to a target of 15 mg twice daily. The dose may be adjusted between 10 mg and 15 mg twice daily based on age and symptoms.
• Children and Adolescents: Safety and effectiveness have not been established.
• Hepatic Impairment: A single 15 mg dose does not cause significant adverse reactions in patients with mild to moderate hepatic impairment. No data is available for severe impairment.
• Renal Impairment:
  • Mild: Initial dose of 5 mg twice daily, increased to 10 mg twice daily after one week.
  • Moderate: Initial dose of 2.5 mg twice daily, increased to 7.5 mg twice daily after one week.
  • Severe: Initial dose of 2.5 mg once daily, increased to 7.5 mg once daily after one week.

Interaction

• Cimetidine or Probenecid: Co-administration may increase Magolin plasma concentration.
• Lorazepam: May potentiate the depressive effects of Lorazepam on the CNS.
• OAT1, OAT3, OCT2, MATE1, MATE2-K, or UGT inhibitors: Use with caution as they may increase mirogabalin exposure.
• Alcohol: Avoid concurrent consumption as Magolin may potentiate the sedating and motor-impairing effects of alcohol.
• Food: No clinically relevant effect on absorption.

Contraindications

Mirogabalin is contraindicated in patients with:

• Hypersensitivity to Mirogabalin.
• Mild to moderate hepatic and renal impairment.

Side Effects

The most commonly reported adverse reactions are somnolence, dizziness, edema, and weight gain. Rarely, patients may experience liver dysfunction (jaundice, nausea, vomiting), dizziness, or a state of impaired consciousness.

Pregnancy & Lactation

• Pregnancy: Administer only if the therapeutic benefit outweighs the potential risks. Animal studies have shown placental passage.
• Lactation: It is transferred into milk in animal studies. The decision to continue or discontinue breastfeeding should be based on a consideration of the therapeutic benefit versus the breastfeeding benefits.

Precautions & Warnings

• CNS Effects: This medicine may cause dizziness, somnolence, or loss of consciousness. Patients should avoid operating dangerous machinery or driving a car. Elderly patients should be cautious about the risk of falls and fractures.
• Weight Gain: The medicine may cause weight gain.
• Vision: It may cause blurred vision and double vision.
• Allergic Reactions: Discontinue use and consult a doctor if an allergic reaction occurs.
• Renal Dysfunction: Dose adjustment is necessary for patients with renal dysfunction.
• Always consult a doctor before taking Magolin with any other medication.

Therapeutic Class

Magolin is classified as an adjunct anti-epileptic drug and a primary anti-epileptic drug.

Storage Conditions

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