Recommended Dosing for Lyrica (Pregabalin)
For neuropathic pain conditions, Lyrica (pregabalin) should be initiated at 50 mg three times daily (150 mg/day) and can be increased to a maximum of 100 mg three times daily (300 mg/day) within one week based on efficacy and tolerability. 1
Dosing by Indication
Diabetic Peripheral Neuropathy
- Initial dose: 50 mg three times daily (150 mg/day)
- Maximum recommended dose: 100 mg three times daily (300 mg/day)
- Titration: May increase to 300 mg/day within 1 week based on efficacy and tolerability
- Higher doses (600 mg/day) provide no additional benefit and are less well tolerated 1
Postherpetic Neuralgia
- Initial dose: 75 mg twice daily or 50 mg three times daily (150 mg/day)
- Recommended dose range: 150-300 mg/day
- Titration: May increase to 300 mg/day within 1 week
- For patients with insufficient pain relief after 2-4 weeks at 300 mg/day who tolerate the medication well, dosing may be increased up to 600 mg/day (300 mg twice daily or 200 mg three times daily) 1
- Reserve doses above 300 mg/day only for patients with ongoing pain who tolerate lower doses 1
Fibromyalgia
- Initial dose: 75 mg twice daily (150 mg/day)
- Recommended dose range: 300-450 mg/day
- Titration: May increase to 300 mg/day within 1 week, with further increase to 450 mg/day if needed
- Doses above 450 mg/day provide no additional benefit and are less well tolerated 1
Adjunctive Therapy for Partial-Onset Seizures
- Adults: Initial dose of 150 mg/day, with maximum dose of 600 mg/day
- Administration: Divided into 2 or 3 doses daily 1
Administration Guidelines
General Administration
- Lyrica can be taken with or without food 1
- Divide daily dose into 2-3 administrations to improve tolerability 2
- When discontinuing, taper gradually over a minimum of 1 week to avoid withdrawal symptoms 1
Dose Adjustments for Special Populations
Renal Impairment
- Pregabalin is eliminated primarily through renal excretion, requiring dose adjustment in patients with reduced renal function 1
- For creatinine clearance <60 mL/min, reduce dose according to renal function 1
Elderly Patients
- Start at lower doses and titrate more slowly due to increased sensitivity to adverse effects 2
Efficacy and Adverse Effects
Efficacy
- For postherpetic neuralgia, the NNT for at least 50% pain relief with 600 mg daily is 3.9 3
- For painful diabetic neuropathy, the NNT for at least 50% pain relief with 600 mg daily is 5.0 3
Common Adverse Effects
- Dizziness (occurs in 27-46% of patients at 600 mg/day)
- Somnolence (occurs in 15-25% of patients at 600 mg/day)
- Peripheral edema (occurs in approximately 10% of patients) 4
- Side effects are generally dose-dependent and can often be managed with dose reduction 4
Clinical Pearls
- Efficacy and adverse effects of pregabalin are dose-related 1
- Slower titration improves tolerability 2
- Taking medication with food may improve tolerability 2
- Pregabalin has limited drug-drug interactions due to minimal metabolism and primarily renal excretion 5
- Monitor for visual field changes, which have been reported in clinical trials 5