Starting Dose of Lyrica When Discontinuing Chronic Gabapentin
When transitioning from chronic gabapentin to pregabalin (Lyrica), the recommended starting dose of pregabalin is 150 mg/day, divided into two or three doses, with gradual titration based on clinical response and tolerability. 1, 2
Conversion Rationale and Strategy
- Pregabalin has superior pharmacokinetics compared to gabapentin, allowing for easier and more rapid titration 1
- The typical effective dosing range for pregabalin in neuropathic pain is 150-600 mg/day, with a maximum recommended dose of 600 mg/day 1, 2
- For most patients, pregabalin should be initiated at 50 mg three times daily (150 mg/day) or 75 mg twice daily (150 mg/day) 1, 2
Gabapentin Discontinuation Process
- Gabapentin should be tapered gradually while pregabalin is being introduced to minimize withdrawal symptoms 3, 4
- Even with a taper, withdrawal symptoms from gabapentin can occur, including restlessness, confusion, agitation, and anxiety 3, 4
- Abrupt discontinuation of gabapentin has been associated with akathisia, which resolves with reintroduction of the medication 5
Pregabalin Titration Schedule
- After initiating pregabalin at 150 mg/day, the dose may be increased to 300 mg/day within one week based on efficacy and tolerability 2
- For neuropathic pain, the dose can be further increased to 600 mg/day for patients who do not experience sufficient pain relief with 300 mg/day after 2-4 weeks 2
- Higher doses (above 300 mg/day) should be reserved for patients with ongoing pain who are tolerating the lower doses 2
Special Considerations
- Both medications require dose adjustment in patients with renal impairment as they are primarily eliminated by renal excretion 1, 2
- Common side effects to monitor during transition include dizziness, somnolence, and mental clouding 1
- Weight gain and peripheral edema may occur with both medications, especially in elderly patients 1, 6
Monitoring During Transition
- Document baseline pain scores before transition to evaluate effectiveness of the conversion 1
- Monitor for withdrawal symptoms from gabapentin, including restlessness, confusion, and anxiety 3, 4
- Watch for pregabalin side effects, particularly neuropsychological reactions like dizziness and drowsiness 6
Common Pitfalls to Avoid
- Avoid abrupt discontinuation of gabapentin, which can lead to withdrawal symptoms even after only one month of treatment 3, 5
- Do not use a one-size-fits-all approach; some patients may require a more individualized tapering schedule based on their clinical response 7
- Be aware that pregabalin, like gabapentin, can lead to weight gain and peripheral edema, especially in elderly patients 6