Maximum Dose of Pregabalin
The maximum recommended dose of pregabalin (Lyrica) is 600 mg/day, typically administered as 200 mg three times daily or 300 mg twice daily, with dose reduction required in patients with impaired renal function. 1, 2
Dosing Guidelines by Indication
Neuropathic Pain Associated with Diabetic Peripheral Neuropathy
- Maximum recommended dose: 300 mg/day 1
- Starting dose: 50 mg three times daily (150 mg/day)
- May increase to 300 mg/day 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
- Maximum recommended dose: 600 mg/day 1
- Starting dose: 75 mg twice daily or 50 mg three times daily (150 mg/day)
- Initial titration to 300 mg/day within 1 week
- For patients without sufficient pain relief after 2-4 weeks at 300 mg/day, may increase to 600 mg/day
- Higher dosing (above 300 mg/day) should be reserved for patients with ongoing pain who are tolerating 300 mg/day 1
Fibromyalgia
- Maximum recommended dose: 450 mg/day 1
- Starting dose: 75 mg twice daily (150 mg/day)
- May increase to 300 mg/day within 1 week
- May further increase to 450 mg/day if insufficient benefit at 300 mg/day
- Although 600 mg/day was studied, there is no evidence of additional benefit, and this dose was less well tolerated 1
Adjunctive Therapy for Partial-Onset Seizures
- Maximum recommended dose: 600 mg/day 1
- Administered in two or three divided doses
Dose 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) | Pregabalin Daily Dose Range (mg/day) |
|---|---|
| ≥60 | 300-600 |
| 30-59 | 150-300 |
| 15-29 | 75-150 |
| <15 | 25-75 |
Important Administration Considerations
- Pregabalin can be taken with or without food 1
- When discontinuing, taper gradually over a minimum of 1 week to avoid withdrawal symptoms 1
- Dose-dependent adverse effects include dizziness (27-46%) and somnolence (15-25%) 2, 3
- Peripheral edema and weight gain may occur, especially in elderly patients 4
- The efficacy of pregabalin appears to be dose-related, but higher doses are associated with increased adverse effects 2, 3
Clinical Pearls
- Pregabalin has linear pharmacokinetics, making dosing more straightforward compared to gabapentin 2
- Initial dosages of 150 mg/day have shown efficacy in some trials 2
- For most neuropathic pain conditions, dosages of 300-600 mg/day are required for optimal efficacy 3
- Consider lower starting dosages and slower titration in geriatric patients 5
- Monitor for visual field restriction, which has been reported in clinical trials 4
- Abuse potential exists, with approximately 9.6% of users taking more than 600 mg/day for extended periods 6
Remember that while higher doses may provide greater pain relief in some patients, they also carry an increased risk of adverse effects. The optimal dose should balance efficacy with tolerability.