Pregabalin (Lyrica) Dosing and Frequency Recommendations
The recommended dose of pregabalin varies by indication, with typical starting doses of 75 mg twice daily or 50 mg three times daily (150 mg/day), which can be titrated up to 300-600 mg/day depending on the condition being treated and patient response. 1
Dosing by Indication
Neuropathic Pain Associated with Diabetic Peripheral Neuropathy
- Starting dose: 50 mg three times daily (150 mg/day)
- Maximum recommended dose: 100 mg three times daily (300 mg/day)
- Titration: May increase to maximum dose within 1 week based on efficacy and tolerability
- Although 600 mg/day was studied, there is no evidence of additional benefit, and this dose was less well tolerated 1
Postherpetic Neuralgia
- Starting dose: 75 mg twice daily or 50 mg three times daily (150 mg/day)
- Recommended dose range: 150-300 mg/day
- Maximum dose: Up to 600 mg/day (300 mg twice daily or 200 mg three times daily) for patients with ongoing pain who tolerate 300 mg/day
- Titration: May increase to 300 mg/day within 1 week based on efficacy and tolerability 1
Fibromyalgia
- Starting dose: 75 mg twice daily (150 mg/day)
- Recommended dose range: 300-450 mg/day
- Titration: May increase to 150 mg twice daily (300 mg/day) within 1 week, and further to 225 mg twice daily (450 mg/day) if needed
- Doses above 450 mg/day are not recommended due to dose-dependent adverse reactions 1
Renal Dose Adjustment
Pregabalin is eliminated primarily by renal excretion, requiring dose adjustment in patients with reduced renal function:
| Creatinine Clearance (mL/min) | Total Daily Dose Range (mg/day) | Dose Regimen |
|---|---|---|
| ≥60 | 150-600 | 2-3 divided doses |
| >30-59 | 75-300 | 2-3 divided doses |
| 15-30 | 25-150 | 1-2 divided doses |
| <15 | 25-75 | Once daily |
| [2,1] |
Administration Guidelines
- Pregabalin can be taken with or without food 1
- When discontinuing, taper gradually over a minimum of 1 week to minimize withdrawal symptoms 1
- Bioavailability is approximately 90% and is not significantly affected by food 3
- Plasma half-life is about 6 hours 3
Pharmacokinetic Considerations
- Pregabalin has >90% bioavailability that is dose-independent, compared to gabapentin which has decreasing bioavailability with increasing doses 2
- Pregabalin requires fewer daily doses (2-3 times daily) compared to gabapentin (3 times daily) 2
- Faster titration is possible with pregabalin (days) compared to gabapentin (weeks) 2
- Therapeutic doses are lower for pregabalin (150-600 mg/day) compared to gabapentin (900-3600 mg/day) 2
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
- Weight gain 2, 4
Clinical Pearls
- Pregabalin shows efficacy in postherpetic neuralgia, painful diabetic neuropathy, and mixed neuropathic pain conditions 4
- The number needed to treat (NNT) for at least 50% pain reduction varies by condition: 3.9 for postherpetic neuralgia, 5.0 for painful diabetic neuropathy, 5.6 for central neuropathic pain, and 11 for fibromyalgia 5
- Treatment discontinuation due to adverse events occurs in approximately 18-28% of patients 5
- Controlled-release formulations are available and provide equivalent daily exposure when administered once daily compared to immediate-release formulations given multiple times per day 6
Remember that individual patient response and tolerability should guide dosing decisions, with careful monitoring for adverse effects, particularly in elderly patients and those with renal impairment.