From the Guidelines
The maximum daily dose of pregabalin for an 80-year-old patient with impaired renal function (GFR 39) is 150-300 mg, divided into two or three doses per day, with careful dose adjustment and monitoring of kidney function and potential side effects 1.
Key Considerations
- Dose Reduction: Due to the patient's reduced renal function, a lower starting dose and slower titration are recommended, as pregabalin is primarily excreted by the kidneys 1.
- Titration: The dose can be titrated up to 300 mg/d after 1 or 2 weeks, but higher doses are not consistently more effective and are associated with a greater rate of adverse effects 1.
- Monitoring: Regular monitoring of kidney function and potential side effects is necessary to ensure safe and effective use of pregabalin in patients with impaired renal function 1.
- Geriatric Patients: Consider lower starting dosages and slower titration in geriatric patients, as they may be more susceptible to adverse effects 1.
Dosage Recommendations
- Start with a low dose, such as 75-150 mg per day, and gradually increase as needed and tolerated 1.
- Divide the daily dose into 2-3 doses per day to minimize side effects and optimize efficacy 1.
From the FDA Drug Label
Table 2 Pregabalin Dosage Adjustment Based on Renal Function Creatinine Clearance (CLcr) (mL/min) Total Pregabalin Daily Dose (mg/day)* ... 30-60 75-300 BID or TID 15-29 25-150 QD or BID <15 25 QD
The maximum daily dose of pregabalin for an 80-year-old with impaired renal function (GFR 39) is 150-300 mg/day, administered in two or three divided doses, based on the dosage adjustment for a creatinine clearance of 30-60 mL/min 2.
From the Research
Maximum Daily Dose of Pregabalin
The maximum daily dose of pregabalin for an 80-year-old with impaired renal function (GFR 39) can be estimated based on the patient's renal function.
- According to the study 3, higher-dose gabapentinoids, including pregabalin, are associated with a higher risk of adverse events in older adults with chronic kidney disease (CKD).
- The study 3 suggests that the starting dose of pregabalin should be lower in patients with CKD, with a recommended dose of ≤75 mg/d.
- Another study 4 found that estimated glomerular filtration rate (eGFR) leads to higher drug dose recommendations in the elderly compared with creatinine clearance, and that dosing discordance was highest with gabapentin, a medication with similar properties to pregabalin.
- The study 5 recommends using the estimated glomerular filtration rate (eGFR) to adjust drug doses in the elderly, and suggests that a good estimation of how much the normal dosing interval should be prolonged, or the dose reduced, can be obtained by calculating the ratio between the patient's eGFR and the normal renal function.
Renal Function and Drug Dosing
- The study 6 highlights the importance of using the correct equation to estimate glomerular filtration rate (GFR) in the elderly, as different equations can lead to different estimates of GFR and potentially affect drug dosing.
- The study 7 found that the use of different formulas to estimate GFR can lead to discordant estimations of kidney function, and that caution should be exercised when using these formulas to adjust drug doses in the elderly.
- The study 4 suggests that until newer equations are used uniformly to develop dosing nomograms, it is prudent to adopt a process for drug dosing in the elderly that is more conservative than eGFR-based dosing, but that considers the potential for underestimating kidney function with the Cockcroft-Gault equation.