Maximum Dose of Pregabalin (Lyrica)
The maximum daily dose of pregabalin (Lyrica) is 600 mg per day for adults, typically divided into two or three equal doses. 1
Dosing Guidelines by Indication
Neuropathic Pain
- Starting dose: 150 mg/day divided into 2-3 doses
- Titration: Can increase to 300 mg/day after one week based on efficacy and tolerability
- Maximum dose: 600 mg/day divided into 2-3 doses
Epilepsy (Partial-Onset Seizures)
- Starting dose: 75 mg twice daily or 50 mg three times daily
- Titration: Can increase based on individual response and tolerability
- Maximum dose: 600 mg/day divided into 2-3 doses
Pediatric Dosing
- For children 4 to <17 years: Maximum 600 mg/day (or 10 mg/kg/day with weight adjustment)
- For children 1 month to <4 years: Maximum 14 mg/kg/day divided into three doses 1
Dose Adjustments for Special Populations
Renal Impairment
Dose adjustment is required for patients with reduced renal function:
- CrCl ≥60 mL/min: No adjustment needed (up to 600 mg/day)
- CrCl 30-59 mL/min: Reduce dose (maximum 300 mg/day)
- CrCl 15-29 mL/min: Further reduction (maximum 150 mg/day)
- CrCl <15 mL/min: Significant reduction (maximum 75 mg/day)
Administration Considerations
- Pregabalin can be administered with or without food
- Dividing the daily dose into either two or three equal doses shows similar efficacy, though three times daily dosing may provide marginally better seizure control 1
- Abrupt discontinuation should be avoided; taper gradually over at least one week
Efficacy Considerations
Efficacy varies by condition:
- Postherpetic neuralgia: Higher response rates (NNT 3.9 for 50% pain reduction at 600 mg/day)
- Diabetic neuropathy: Moderate response rates (NNT 7.8 for 50% pain reduction at 600 mg/day)
- Central neuropathic pain: Lower response rates (NNT 9.8 for 50% pain reduction)
- HIV neuropathy: No evidence of benefit at 600 mg/day 2
Common Adverse Effects
At the maximum dose of 600 mg/day:
- Dizziness: 27-46% of patients
- Somnolence: 15-25% of patients
- Peripheral edema: More common in elderly patients
- Weight gain: Dose-dependent effect 3, 2
Important Considerations
- Serious adverse events occur at similar rates to placebo, indicating a relatively safe profile 2
- Monitor for neuropsychological reactions, especially in elderly patients
- Pregabalin is a Schedule V controlled substance due to potential for abuse and dependence 4
- Pregabalin has minimal drug interactions due to lack of hepatic metabolism and no interaction with cytochrome P-450 enzymes 4
While pregabalin can be effective for neuropathic pain conditions, it's important to recognize that not all patients will respond, and dose adjustments should be made based on both efficacy and tolerability within the maximum daily dose of 600 mg.