From the FDA Drug Label
In view of dose-dependent adverse reactions and since pregabalin is eliminated primarily by renal excretion, adjust the dose in adult patients with reduced renal function. The use of pregabalin in pediatric patients with compromised renal function has not been studied Base the dose adjustment in patients with renal impairment on creatinine clearance (CLcr), as indicated in Table 2. Table 2 Pregabalin Dosage Adjustment Based on Renal Function Creatinine Clearance (CLcr) (mL/min) Total Pregabalin Daily Dose (mg/day)* 30-60 225 mg/day BID or TID ...
The recommended dosing of Lyrica (pregabalin) in a patient with chronic kidney disease stage 3 (CKD3) and impaired renal function is to adjust the dose based on creatinine clearance (CLcr).
- For a CLcr of 30-60 mL/min, the total daily dose is 225 mg/day, administered in two or three divided doses 1. Key points:
- Dose adjustment is necessary in patients with reduced renal function
- Use Table 2 to determine the corresponding renal adjusted dose based on CLcr
- For patients with CLcr of 30-60 mL/min, the recommended dose is 225 mg/day, administered in two or three divided doses.
From the Research
For patients with chronic kidney disease stage 3 (CKD3) and impaired renal function, Lyrica (pregabalin) dosing should be reduced to 75-300 mg/day divided into 2-3 doses. The specific dosing adjustment depends on the patient's creatinine clearance, which in CKD3 typically ranges from 30-59 mL/min. For patients with creatinine clearance between 30-60 mL/min, start with 75 mg twice daily (150 mg/day) and titrate cautiously based on response and tolerability, not exceeding 300 mg/day. Dose adjustment is necessary because pregabalin is primarily eliminated unchanged through the kidneys, and reduced renal function leads to drug accumulation and increased risk of adverse effects such as dizziness, somnolence, and peripheral edema, as seen in a study evaluating gabapentinoid use in patients with decreased kidney function 2. Regular monitoring of renal function is essential, and dose should be reassessed if kidney function deteriorates further. If the patient experiences excessive side effects even at lower doses, consider once-daily dosing or further dose reduction while monitoring for efficacy. It's also important to note that patients with CKD are at risk for other complications, but the provided evidence on vitamins and other treatments 3, 4, 5 is not directly relevant to Lyrica dosing in CKD3. Therefore, the primary consideration should be the patient's renal function and the potential for drug accumulation, as highlighted in the most recent study on gabapentinoid use in hospitalized patients with decreased kidney function 2.