Pregabalin Dosage Recommendations for Neuropathic Pain and Epilepsy
The recommended dosage of pregabalin varies by indication, with neuropathic pain typically requiring 150-300 mg/day and epilepsy requiring 150-600 mg/day, with dosing adjustments based on renal function and patient response. 1
Dosage for Neuropathic Pain
Diabetic Peripheral Neuropathy
- Initial dose: 50 mg three times daily (150 mg/day)
- May increase to 300 mg/day within 1 week based on efficacy and tolerability
- Maximum recommended dose: 300 mg/day (100 mg three times daily)
- Higher doses do not confer additional benefits and have more adverse effects 1
Postherpetic Neuralgia
- Initial dose: 75 mg twice daily or 50 mg three times daily (150 mg/day)
- May increase to 300 mg/day within 1 week based on efficacy and tolerability
- Maximum dose: 600 mg/day (300 mg twice daily or 200 mg three times daily)
- Doses above 300 mg/day should be reserved for patients with ongoing pain who tolerate 300 mg/day 1
Neuropathic Pain Associated with Spinal Cord Injury
- Initial dose: 75 mg twice daily (150 mg/day)
- May increase to 300 mg/day within 1 week based on efficacy and tolerability
- Maximum dose: 600 mg/day (300 mg twice daily)
- Dose range: 150-600 mg/day 1
Dosage for Epilepsy (Adjunctive Therapy for Partial-Onset Seizures)
Adults (17 years and older)
- Initial dose: 150 mg/day
- Maximum dose: 600 mg/day
- Administer in 2 or 3 divided doses 1
Pediatric Patients
- For patients ≥30 kg: Initial 2.5 mg/kg/day; maximum 10 mg/kg/day (not exceeding 600 mg/day)
- For patients <30 kg: Initial 3.5 mg/kg/day; maximum 14 mg/kg/day
- Administer in 2-3 divided doses (3 divided doses for children <4 years) 1
Dosage Adjustments for Renal Impairment
Pregabalin is primarily eliminated by renal excretion, requiring dose adjustment in patients with reduced renal function 2, 1:
| Creatinine Clearance (mL/min) | Dose Adjustment |
|---|---|
| ≥60 | No adjustment needed |
| 30-59 | Reduce daily dose by 50% |
| 15-29 | Reduce daily dose by 75% |
| <15 | Further reduction based on individual response |
For hemodialysis patients, administer a supplemental dose immediately following each 4-hour hemodialysis treatment 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
- Dose escalation should be gradual, approximately weekly, based on clinical response and tolerability 1
- Both efficacy and adverse event profiles are dose-related 1, 3
Clinical Considerations
- Higher doses of pregabalin have shown greater efficacy in improving pain outcomes, but also increased adverse effects 3
- Many patients who do not respond to lower doses may respond when the dose is escalated appropriately 3
- Common adverse effects include dizziness (23.1%), drowsiness (14.6%), and peripheral edema (10.4%) 4
- Monitor for peripheral edema, especially at higher doses 2
- Male gender and concurrent use of antipsychotics or benzodiazepines are associated with increased risk of pregabalin use above recommended dosages 5
Cautions
- Avoid abrupt discontinuation
- Use with caution in patients with a history of substance use disorders 2
- Monitor elderly patients and those with cardiovascular disease more closely 2
- Watch for emergence or worsening of depression or suicidal thoughts 2
- Use caution when combining with other CNS depressants 2
Pregabalin dosing should be optimized to the lowest effective dose that provides adequate symptom control while minimizing adverse effects.