From the Guidelines
Pregabalin (Lyrica) is typically prescribed at starting doses of 50 mg 3 times a day, with gradual increases up to 300-600 mg daily depending on the condition being treated, as recommended by recent guidelines 1.
Recommended Uses and Dosages
The recommended dosages and uses of Pregabalin (Lyrica) vary depending on the condition being treated.
- For neuropathic pain, including diabetic peripheral neuropathy and postherpetic neuralgia, the recommended dose is 150-600 mg daily, with a starting dose of 50 mg 3 times a day, increasing to 100 mg 3 times a day, and further increases up to a maximum dose of 600 mg in divided doses 3 times a day, as needed and tolerated 1.
- For fibromyalgia, 300-450 mg daily is typically effective, although the exact dosage may vary depending on the individual patient's response and tolerance.
- For partial onset seizures, 150-600 mg daily is used as adjunctive therapy, with a starting dose of 50 mg 3 times a day, or 75 mg twice daily, and gradual increases as needed and tolerated 1.
- For generalized anxiety disorder, 150-600 mg daily is recommended, although the exact dosage may vary depending on the individual patient's response and tolerance.
Mechanism of Action and Side Effects
Pregabalin works by binding to calcium channels in the central nervous system, reducing the release of excitatory neurotransmitters and thereby decreasing pain signals and seizure activity.
- Common side effects include dizziness, drowsiness, dry mouth, edema, blurred vision, and weight gain.
- Dosage adjustments are necessary for patients with reduced kidney function, and pregabalin should be tapered gradually when discontinuing to avoid withdrawal symptoms.
- Patients should take pregabalin at the same times each day with or without food and should not abruptly stop taking the medication without consulting their healthcare provider.
Key Considerations
- The efficacy and tolerability of pregabalin seem to be similar to those of gabapentin, but pregabalin has linear pharmacokinetics, and dosing is more straightforward 1.
- Most patients can start taking the drug at 150 mg/d in 2 or 3 divided doses, which is then titrated up to 300 mg/d after 1 or 2 weeks, and further increases up to 600 mg/d as needed and tolerated 1.
- 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, and the time required to titrate to a full dosage is less 1.
From the FDA Drug Label
2.1 Important Administration Instructions Pregabalin is given orally with or without food. 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.
The recommended dosages of Pregabalin (Lyrica) 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: included in Table 1, with a maximum dosage of 600 mg/day
- Management of Fibromyalgia: 300 to 450 mg/day The uses of Pregabalin (Lyrica) are:
- Neuropathic Pain Associated with Diabetic Peripheral Neuropathy
- Postherpetic Neuralgia
- Adjunctive Therapy for Partial-Onset Seizures
- Management of Fibromyalgia 2
From the Research
Recommended Dosages of Pregabalin
- The recommended dosage of pregabalin for neuropathic pain associated with diabetic peripheral neuropathy is 150-300 mg per day, divided into 2-3 daily doses 3.
- For postherpetic neuralgia, the recommended dosage is 150-600 mg per day, divided into 2-3 daily doses 4, 3.
- For refractory partial-onset seizures, the recommended dosage is 150-600 mg per day, divided into 2-3 daily doses 4, 5.
- For generalized anxiety disorder, the recommended dosage is 150-600 mg per day, divided into 2-3 daily doses 4, 6, 7.
Uses of Pregabalin
- Pregabalin is used to treat neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia 4, 3.
- It is also used as an adjunctive treatment for refractory partial-onset seizures 4, 5.
- Pregabalin is used to treat generalized anxiety disorder, including monotherapy in elderly patients and adjunctive therapy in patients who have failed to respond to an initial course of antidepressant therapy 6, 7.
- It has anxiolytic, anticonvulsant, and analgesic activities, making it a useful addition to the therapeutic armamentarium for these conditions 4, 6, 5, 3, 7.
Adverse Effects of Pregabalin
- The most common adverse effects of pregabalin are dizziness, somnolence, and headache 4, 6, 5, 3, 7.
- Other adverse effects include peripheral edema, weight gain, and ataxia 4, 5, 3.
- Pregabalin appears to have a low potential for causing withdrawal symptoms when long-term therapy is discontinued, but tapering over the course of at least one week is recommended 6, 7.