Recommended Dosage of Lyrica (Pregabalin)
The recommended dosage of Lyrica (pregabalin) varies by indication, with a maximum recommended dose of 600 mg per day divided into two or three doses, and should be adjusted based on renal function, age, and clinical response. 1, 2
General Dosing Guidelines
- Initial dosing should start at 75 mg twice daily or 50 mg three times daily, with gradual weekly increases to reach effective dose 2, 3
- Administer pregabalin in 2-3 divided doses per day 2
- Pregabalin can be taken with or without food, as food does not significantly affect absorption 1, 4
- When discontinuing pregabalin, taper gradually over a minimum of 1 week to avoid withdrawal symptoms 1
Indication-Specific Dosing
Neuropathic Pain Associated with Diabetic Peripheral Neuropathy
- Start with 50 mg three times daily (150 mg/day) 1
- May increase to 300 mg/day within 1 week based on efficacy and tolerability 1
- Maximum recommended dose is 300 mg/day (100 mg three times daily) 1
- Higher doses (600 mg/day) do not confer additional benefits and are less well tolerated 1
Postherpetic Neuralgia
- Start with 75 mg twice daily or 50 mg three times daily (150 mg/day) 1
- May increase to 300 mg/day within 1 week based on efficacy and tolerability 1
- For patients with insufficient pain relief after 2-4 weeks at 300 mg/day, dose may be increased up to 600 mg/day (300 mg twice daily or 200 mg three times daily) 1
- Doses above 300 mg/day should be reserved for patients with ongoing pain who are tolerating 300 mg/day 1
Fibromyalgia
- Start with 75 mg twice daily (150 mg/day) 1
- May increase to 300 mg/day within 1 week 1
- If insufficient benefit at 300 mg/day, may further increase to 450 mg/day (225 mg twice daily) 1
- Maximum recommended dose is 450 mg/day 1
Adjunctive Therapy for Partial-Onset Seizures
- For adults (17 years and older): Initial dose of 150 mg/day, with maximum dose of 600 mg/day 1
- Administer in 2 or 3 divided doses 1
Special Populations
Renal Impairment
- Dose adjustment is required for patients with renal impairment, as pregabalin is primarily excreted unchanged by the kidneys 2, 1
- Pregabalin has approximately 90% oral bioavailability and 95% appears unchanged in urine, making renal function an important consideration 4
Elderly Patients
- Consider lower starting doses and slower titration in elderly patients due to increased risk of adverse effects 2, 3
- Common side effects in elderly include dizziness, somnolence, and confusion 2
Efficacy and Monitoring
- Pregabalin can show noticeable effect on neuropathic pain within 1 week 3
- A full assessment of efficacy requires 4 weeks of treatment 3, 5
- In clinical trials, pregabalin showed efficacy for neuropathic pain conditions at doses of 300 mg, 450 mg, and 600 mg daily 5, 6
- Pregabalin at 150 mg daily was generally ineffective for most conditions 5
Side Effects
- Common side effects include dizziness (23-46%), somnolence (15-25%), dry mouth, and constipation 2, 6
- Side effects are generally dose-dependent and can be managed with dose reduction 2
- Peripheral edema occurs in approximately 10% of patients 2
- In clinical trials, somnolence typically occurred in 15-25% of patients and dizziness in 27-46% of patients at 600 mg daily 5
Important Considerations
- Pregabalin has more predictable absorption and linear pharmacokinetics compared to gabapentin 2
- When switching from gabapentin to pregabalin, the recommended starting dose is 50 mg three times daily or 75 mg twice daily 2
- The maximum dose of gabapentin is 3600 mg/day compared to 600 mg/day for pregabalin 2
- Pregabalin has a plasma half-life of about 6 hours, which is not dose-dependent 4