Maximum Daily Dose of Pregabalin (Lyrica)
The maximum daily dose of pregabalin (Lyrica) is 600 mg per day, administered in divided doses. 1, 2
Dosing Guidelines by Indication
Neuropathic Pain Associated with Diabetic Peripheral Neuropathy
- Recommended maximum dose: 300 mg/day
- Initial dose: 50 mg three times daily (150 mg/day)
- May increase to 300 mg/day within 1 week based on efficacy and tolerability
- Although pregabalin was studied at 600 mg/day, there is no evidence of additional benefit at this higher dose, and it was less well tolerated 1
Postherpetic Neuralgia
- Recommended dose range: 150-600 mg/day
- Initial dose: 75 mg twice daily or 50 mg three times daily (150 mg/day)
- May increase to 300 mg/day within 1 week
- Doses above 300 mg/day (up to 600 mg/day) should be reserved for patients who:
- Do not experience sufficient pain relief after 2-4 weeks at 300 mg/day
- Can tolerate pregabalin at lower doses
- Have ongoing pain 1
Fibromyalgia
- Recommended dose range: 300-450 mg/day
- Initial dose: 75 mg twice daily (150 mg/day)
- May increase to 300 mg/day within 1 week 1
Adjunctive Therapy for Partial-Onset Seizures
- Maximum dose: 600 mg/day
- Administered in 2 or 3 divided doses
- Dosing should be titrated based on clinical response and tolerability 1
Administration Considerations
Dosing Schedule
- Pregabalin can be administered in 2-3 divided doses per day
- Can be taken with or without food 1
Discontinuation
- When discontinuing pregabalin, taper gradually over a minimum of 1 week to minimize withdrawal symptoms 1
Renal Impairment Adjustments
Pregabalin is primarily eliminated by renal excretion, so dosage adjustment is required 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 |
| 15-29 | 25-150 | 1-2 divided doses |
| <15 | 25-75 | Once daily |
Adverse Effects
Common adverse effects at the maximum dose of 600 mg/day include:
- Dizziness (27-46%)
- Somnolence (15-25%)
- Weight gain
- Peripheral edema 2
Higher rates of adverse events are observed in patients ≥65 years, requiring careful dose titration and monitoring 2.
Clinical Considerations
- Pregabalin has proven efficacy in neuropathic pain conditions and fibromyalgia 3
- Higher rates of substantial benefit were found in postherpetic neuralgia and painful diabetic neuropathy compared to central neuropathic pain and fibromyalgia 3
- There is no evidence supporting the use of pregabalin in acute pain scenarios or chronic nociceptive pain like arthritis 3
- The effect of dose escalation rate on tolerability has not been formally studied 1