Lyrica (Pregabalin) Dosing Recommendations
The recommended dosing for Lyrica (pregabalin) varies by indication, with initial doses typically starting at 50-75 mg three times daily (150 mg/day) and titrating up to a maximum of 300-600 mg/day depending on the condition being treated and patient response.
Dosing by Indication
Neuropathic Pain Associated with Diabetic Peripheral Neuropathy
- Initial dose: 50 mg three times daily (150 mg/day)
- Titration: May increase to 300 mg/day within 1 week based on efficacy and tolerability
- Maximum recommended dose: 100 mg three times daily (300 mg/day)
- Note: Although pregabalin was studied at 600 mg/day, there is no evidence of additional benefit, and this dose was less well tolerated 1
Postherpetic Neuralgia
- Initial dose: 75 mg twice daily or 50 mg three times daily (150 mg/day)
- Titration: May increase to 300 mg/day within 1 week based on efficacy and tolerability
- Standard dose range: 150-300 mg/day
- Maximum dose: For patients with ongoing pain who tolerate 300 mg/day, dosing may be increased up to 600 mg/day (300 mg twice daily or 200 mg three times daily) 1
Adjunctive Therapy for Partial-Onset Seizures
- Initial dose: 150 mg/day
- Titration: Based on clinical response and tolerability, may increase approximately weekly
- Maximum dose: 600 mg/day
- Administration: Divide into 2 or 3 doses per day 1
Fibromyalgia
- Initial dose: 75 mg twice daily (150 mg/day)
- Titration: May increase to 300 mg/day within 1 week based on efficacy and tolerability
- Standard dose range: 300-450 mg/day
- Maximum dose: 450 mg/day (225 mg twice daily)
- Note: Although pregabalin was studied at 600 mg/day, there is no evidence of additional benefit, and this dose was less well tolerated 1
Administration Guidelines
- Pregabalin can be taken with or without food 1
- When discontinuing pregabalin, taper gradually over a minimum of 1 week to avoid withdrawal symptoms 1
- For neuropathic pain, doses should be divided into 2-3 administrations per day 1
Dose Adjustments for Special Populations
Renal Impairment
Because pregabalin is eliminated primarily by renal excretion, dose adjustment is required in patients with reduced renal function:
| Creatinine Clearance (mL/min) | Total Pregabalin Daily Dose | Dose Regimen |
|---|---|---|
| ≥60 | 150-600 mg | BID or TID |
| 30-60 | 75-300 mg | BID or TID |
| 15-30 | 25-150 mg | Once daily or BID |
| <15 | 25-75 mg | Once daily |
Efficacy and Side Effects
Efficacy
- In postherpetic neuralgia, 50% of patients achieved at least 30% pain reduction with pregabalin 300 mg/day compared to 25% with placebo 2
- In diabetic neuropathy, 47% of patients achieved at least 30% pain reduction with pregabalin 300 mg/day compared to 42% with placebo 2
Common Side Effects
- Dizziness: 27-46% at 600 mg/day 3
- Somnolence: 15-25% at 600 mg/day 3
- Peripheral edema: Particularly in elderly patients 4
- Weight gain: Common side effect 4
Clinical Pearls
- Titration: Start low and titrate slowly to minimize side effects
- Monitoring: Assess efficacy and side effects regularly during dose titration
- Discontinuation: Always taper gradually when stopping treatment
- Comparison to gabapentin: Pregabalin has similar efficacy and side effect profile to gabapentin but with potentially better bioavailability 4
- Drug interactions: Limited risk of interactions involving cytochrome P450 4
Cautions
- Pregabalin may cause visual field restriction in some patients 4
- Higher doses are associated with increased risk of adverse effects without consistently providing better pain relief 5
- Individualize dosing based on efficacy and tolerability, as many patients will have no or trivial benefit, or will discontinue due to adverse events 3