What is the recommended dose of Lyrica (pregabalin) for treating neuropathy in the feet?

From the Guidelines

The recommended dose of Lyrica (pregabalin) for treating neuropathy in the feet is 300-600 mg per day, with a starting dose of 75 mg taken orally twice daily (150 mg/day), as supported by the most recent and highest quality study 1. This dose may be gradually increased based on individual response and tolerability. The maximum recommended dose is 600 mg per day. Some key points to consider when prescribing Lyrica include:

• Patients with reduced kidney function require lower doses.
• Lyrica should be taken consistently with or without food.
• It should not be stopped abruptly as this may cause withdrawal symptoms.
• It works by binding to calcium channels in the nervous system, reducing the release of excitatory neurotransmitters that transmit pain signals.
• Improvement may take several weeks, and side effects can include dizziness, drowsiness, weight gain, and swelling in the extremities.
• Patients should be aware that Lyrica may cause drowsiness and impair driving ability, and should avoid alcohol while taking this medication as it can increase sedative effects. The American Academy of Neurology recommends that the initial treatment of pain should also focus on the concurrent treatment of both sleep and mood disorders because of increased frequency of these problems in individuals with diabetic peripheral neuropathy (DPN) 1. Gabapentinoids, such as pregabalin, are considered first-line treatments for neuropathic pain, with eight high-quality studies and seven medium-quality studies supporting the role of pregabalin in the treatment of pain in DPN 1. Adverse effects may be more severe in older individuals and may be attenuated by lower starting doses and more gradual titration 1. It is essential to carefully evaluate the benefits and risks of Lyrica and other treatments for neuropathic pain, considering the individual patient's needs and medical history.

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. Begin dosing at 50 mg three times a day (150 mg/day). The dose may be increased to 300 mg/day within 1 week based on efficacy and tolerability Although pregabalin was also studied at 600 mg/day, there is no evidence that this dose confers additional significant benefit and this dose was less well tolerated. In view of the dose-dependent adverse reactions, treatment with doses above 300 mg/day is not recommended [see ADVERSE REACTIONS (6.1)].

The recommended dose of Lyrica (pregabalin) for treating neuropathy in the feet due to diabetic peripheral neuropathy is:

• Initial dose: 50 mg three times a day (150 mg/day)
• Maximum dose: 100 mg three times a day (300 mg/day) 2

From the Research

Recommended Dose of Lyrica (Pregabalin) for Neuropathy in Feet

The recommended dose of Lyrica (pregabalin) for treating neuropathy in the feet can vary depending on the individual and the specific condition being treated.

• According to a study published in the Journal of Pain Research 3, higher doses of pregabalin have been shown to be more effective in improving pain outcomes, but the dose should be individualized according to patient response and tolerability.
• A review of 45 studies on the use of pregabalin for neuropathic pain found that doses of 300 mg and 600 mg per day were effective in reducing pain intensity in patients with postherpetic neuralgia, painful diabetic neuropathy, and mixed neuropathic pain 4.
• The study also found that somnolence and dizziness were more common with pregabalin than with placebo, particularly at higher doses.

Dose Titration

• The study published in the Journal of Pain Research 3 suggests that dose titration is important to achieve optimal pain relief with pregabalin.
• The review of 45 studies 4 also found that dose titration was necessary to achieve optimal pain relief, with some patients requiring doses of up to 600 mg per day.

Comparison with Other Medications

• A study published in the Journal of the Association of Physicians of India 5 compared the effectiveness of pregabalin with duloxetine in patients with diabetic peripheral neuropathic pain and found that duloxetine was more effective, but pregabalin had a better safety profile and tolerability.
• Another study published in the Journal of Pain Research 6 discussed the potential role of mirogabalin, a new therapy for diabetic neuropathy, and its efficacy and tolerability in clinical trials.

Note: There is no direct evidence from the provided studies regarding the specific dose of Lyrica for neuropathy in feet, but the information provided can be used as a general guideline for the treatment of neuropathic pain with pregabalin.