What is the typical dosing regimen for pregabalin (lyrica)?

Pregabalin Dosing Regimen

The typical dosing regimen for pregabalin (Lyrica) starts at 50 mg three times daily or 75 mg twice daily, with titration to 300 mg/day after 3-7 days, and can be further increased to a maximum of 600 mg/day (200 mg three times daily or 300 mg twice daily) based on efficacy and tolerability. 1

Initial Dosing and Titration

• Starting dose options:

  • 50 mg three times daily (150 mg/day)
  • 75 mg twice daily (150 mg/day) 1, 2

• Titration schedule:

  • Increase to 300 mg/day after 3-7 days
  • Further increase by 150 mg/day every 3-7 days as tolerated 1
  • Most patients can start at 150 mg/day in 2-3 divided doses 1

• Target dose range:

  • 300-600 mg/day for most neuropathic pain conditions 1, 2
  • 300 mg/day is often effective and better tolerated than higher doses 1

Maximum Dosing

• Maximum recommended dose: 600 mg/day (200 mg three times daily or 300 mg twice daily) 1
• Note: Higher dosages are not consistently more effective than 300 mg/day and are associated with more adverse effects 1
• For specific conditions:
  • Neuropathic pain associated with spinal cord injury: 150-600 mg/day 3, 4
  • Postherpetic neuralgia: Significant benefit observed at 150 mg/day 5
  • Diabetic neuropathy: Dose-dependent response with significant benefit at 300 mg/day 5

Dosing in Renal Impairment

Pregabalin is primarily eliminated by renal excretion (98%), so dose adjustment is necessary in patients with reduced renal function 3, 5, 6:

Creatinine Clearance (mL/min)	Pregabalin Daily Dose Range
≥60	300-600 mg/day
30-59	150-300 mg/day
15-29	75-150 mg/day
<15	25-75 mg/day

• For hemodialysis patients: Administer a supplemental dose immediately following every 4-hour hemodialysis treatment 3

Administration Considerations

• Pregabalin can be taken with or without food 6, 7
• Divided dosing is recommended (twice or three times daily) 1, 2
• Pregabalin has linear pharmacokinetics, making dosing more straightforward than gabapentin 1, 6
• Time to maximum plasma concentration is approximately 1 hour 6, 7
• Steady state is achieved within 24-48 hours 6

Common Adverse Effects

• Dose-dependent side effects:

  • Dizziness (23-35%)
  • Somnolence (15-25%)
  • Peripheral edema (10.4%) 1, 5, 8

• Management of side effects:

  • Start with lower doses and titrate cautiously to minimize adverse effects
  • Side effects are generally mild to moderate and can be managed by dose reduction 1, 5

Clinical Pearls

• Pregabalin may provide analgesia more quickly than gabapentin due to its linear pharmacokinetics and because the initial dose of 150 mg/day has been found efficacious in some trials 1
• In the United States, pregabalin is a Schedule V controlled substance 1
• Duration of an adequate trial is approximately 4 weeks 1
• For elderly patients, consider lower starting doses and slower titration 1
• Pregabalin has minimal drug interactions as it is not metabolized by the liver and doesn't affect cytochrome P450 enzymes 6