Maximum Dose of Pregabalin
The maximum recommended dose of pregabalin is 600 mg per day, typically divided into two or three doses. 1
Dosage Information for Pregabalin
Standard Dosing
- For patients currently taking 150mg twice daily (300mg/day):
- This is within the therapeutic range for most indications
- The dose can be increased up to 600mg/day if needed for better pain control
- Dosing is typically divided into 2-3 doses per day
Maximum Doses by Indication
Neuropathic Pain Associated with Diabetic Peripheral Neuropathy:
- Maximum: 300mg/day (100mg three times daily) 1
- Although higher doses were studied, no additional benefit was observed beyond 300mg/day
Postherpetic Neuralgia:
- Maximum: 600mg/day (300mg twice daily or 200mg three times daily) 1
- Doses above 300mg/day should be reserved for patients with ongoing pain who tolerate 300mg/day
Fibromyalgia:
- Maximum: 450mg/day (225mg twice daily) 1
- No additional benefit observed at 600mg/day with increased adverse effects
Dosage Adjustments
Renal Function Considerations
Pregabalin is eliminated primarily by renal excretion, so dose adjustment is necessary for patients with reduced renal function 1:
| Creatinine Clearance (mL/min) | Total Daily Dose Range |
|---|---|
| ≥60 | 150-600 mg/day |
| 30-59 | 75-300 mg/day |
| 15-29 | 25-150 mg/day |
| <15 | 25-75 mg/day |
Titration Recommendations
- Begin with lower doses and titrate up based on efficacy and tolerability 2
- For most patients, efficacy is observed within the 150-600 mg/day dose range 2
- Slower titration is recommended for elderly patients 3
Efficacy and Safety Considerations
- Pregabalin has a linear and predictable pharmacokinetic profile 4
- Common side effects include dizziness, somnolence, peripheral edema, and weight gain 2
- Side effects are dose-dependent, with higher incidence at higher doses 5
- Somnolence rates: 11-16% at 300mg/day vs 15-25% at 600mg/day 6
- Dizziness rates: 13-29% at 300mg/day vs 22-35% at 600mg/day 6
Important Clinical Considerations
- When discontinuing pregabalin, taper gradually over a minimum of 1 week to avoid withdrawal symptoms 1
- Pregabalin can be taken with or without food 1
- High-dose use (≥600 mg/day for extended periods) occurs in approximately 9.6% of users 7
- For patients not responding adequately to pregabalin monotherapy, combination with other agents may be considered 3
Remember that while 600mg/day is the absolute maximum dose for pregabalin, the optimal therapeutic dose varies by indication, with some conditions (like diabetic neuropathy) having lower maximum recommended doses due to lack of additional benefit at higher doses.