What are the doses of pregabalin?

From the Guidelines

Pregabalin doses typically start at 50 mg 3 times daily or 75 mg twice daily, with a maximum dosage of 600 mg/d.

Dosing Details

• The dose can be increased to 300 mg/d after 3-7 days, and then by 150 mg/d every 3-7 days as tolerated 1.
• For patients who tolerate 300 mg/d but have inadequate pain relief, the dosage can be further titrated to 600 mg/d 1.
• However, higher dosages are not consistently more effective than 300 mg/d and are associated with a greater rate of adverse effects 1.
• In patients with renal insufficiency, dosage adjustment is required 1.

Clinical Considerations

• Pregabalin may provide analgesia more quickly than gabapentin because the initial dosage of 150 mg/d has been found to be efficacious in some trials 1.
• Pregabalin has linear pharmacokinetics, and dosing is more straightforward compared to gabapentin 1.
• The most common adverse effects of pregabalin are dose-dependent dizziness and sedation, which can be reduced by starting with lower dosages and titrating cautiously 1.
• Pregabalin should be prescribed with caution in patients with a history of psychiatric disease or addiction, as it may cause euphoria 1.

From the FDA Drug Label

2.2 Neuropathic Pain Associated with Diabetic Peripheral Neuropathy in Adults The maximum recommended dose of pregabalin is 100 mg three times a day (300 mg/day) in patients with creatinine clearance of at least 60 mL/min.

2.3 Postherpetic Neuralgia in Adults The recommended dose of pregabalin is 75 to 150 mg two times a day, or 50 to 100 mg three times a day (150 to 300 mg/day) in patients with creatinine clearance of at least 60 mL/min.

2.4 Adjunctive Therapy for Partial-Onset Seizures in Patients 1 Month of Age and Older The recommended dosages for adults and pediatric patients 1 month of age and older are included in Table 1.

2.5 Management of Fibromyalgia in Adults The recommended dose of pregabalin for fibromyalgia is 300 to 450 mg/day.

2.6 Neuropathic Pain Associated with Spinal Cord Injury in Adults The recommended dose range of pregabalin for the treatment of neuropathic pain associated with spinal cord injury is 150 to 600 mg/day.

The doses of pregabalin are:

• Neuropathic Pain Associated with Diabetic Peripheral Neuropathy: 100 mg three times a day (300 mg/day)
• Postherpetic Neuralgia: 75 to 150 mg two times a day, or 50 to 100 mg three times a day (150 to 300 mg/day)
• Adjunctive Therapy for Partial-Onset Seizures:
  • Adults: 150 mg/day to 600 mg/day
  • Pediatric patients: dependent on body weight, 2.5 mg/kg/day to 10 mg/kg/day (not to exceed 600 mg/day)
• Management of Fibromyalgia: 300 to 450 mg/day
• Neuropathic Pain Associated with Spinal Cord Injury: 150 to 600 mg/day 2

From the Research

Doses of Pregabalin

• The doses of pregabalin vary depending on the condition being treated, with studies indicating the following doses:
  • 150 mg daily, which was generally ineffective in some studies 3
  • 300 mg daily, which was effective in patients with postherpetic neuralgia, painful diabetic neuropathy, central neuropathic pain, and fibromyalgia 3
  • 450 mg daily, which was also effective in patients with postherpetic neuralgia, painful diabetic neuropathy, central neuropathic pain, and fibromyalgia 3
  • 600 mg daily, which was effective in patients with postherpetic neuralgia, painful diabetic neuropathy, central neuropathic pain, and fibromyalgia, with the best (lowest) NNT for each condition for at least 50% pain relief over baseline (substantial benefit) 3
• In patients with fibromyalgia, a once daily controlled-release formulation of pregabalin was evaluated, with a starting dose of 165 mg/day, which was escalated up to 495 mg/day based on efficacy and tolerability 4
• The initial recommended dose of pregabalin for neuropathic pain is 150 mg per day, which can be increased up to 300 mg per day (divided into 2-3 daily doses) during a one-week period, depending on the patient's response or bodily resistance to the drug 5
• The starting dosage for patients with neuropathic pain associated with diabetic peripheral neuropathy is 50 mg three times daily, which may be increased to 300 mg daily within one week based on efficacy and tolerability 6
• The starting dosage for patients with partial-onset seizures is 75 mg twice daily or 50 mg three times daily, which may be increased to 600 mg daily based on individual response and tolerability 6

Administration and Pharmacokinetics

• Pregabalin is rapidly absorbed and exhibits linear pharmacokinetics after oral administration 7, 6
• The time to maximal plasma concentration is approximately 1 hour, and steady state is achieved within 24-48 hours 7
• Pregabalin does not bind to plasma proteins and is excreted virtually unchanged (<2% metabolism) by the kidneys 7
• Administration with food has no clinically relevant effect on the amount of pregabalin absorbed 7