Maximum Doses of Pregabalin and Gabapentin for Anxiety
For anxiety treatment, the maximum dose of pregabalin is 600 mg/day, while gabapentin's maximum dose is 3600 mg/day, though doses above 1800 mg/day for gabapentin have not demonstrated additional benefit for anxiety. 1, 2
Pregabalin Dosing for Anxiety
- The effective dose range for pregabalin in generalized anxiety disorder (GAD) is 150-600 mg/day, with optimal efficacy typically seen between 200-450 mg/day 3, 2
- Peak reduction in anxiety symptoms occurs at approximately 450 mg/day, with minimal additional benefit beyond this dose 4
- For psychic anxiety symptoms, maximum efficacy is reached at approximately 400 mg/day, while somatic anxiety symptoms may continue to improve up to 600 mg/day 4
- The dose of 150 mg/day is generally considered insufficient for treating GAD 3
- Pregabalin can be administered in divided doses, typically twice or three times daily 5
Gabapentin Dosing for Anxiety
- While not FDA-approved specifically for anxiety, gabapentin is commonly used off-label for this indication 1
- The maximum FDA-approved dose for gabapentin is 3600 mg/day, though this is primarily based on epilepsy studies 1
- For off-label anxiety treatment, dosing typically follows similar patterns to those used for neuropathic pain: starting with 300 mg/day and gradually titrating up 6
- The recommended maintenance dose range is 900-3600 mg/day, administered in three divided doses 1
- Clinical experience suggests that doses above 1800 mg/day may not provide additional benefit for anxiety symptoms, similar to what's observed in pain management 1
Dosing Considerations and Safety
- Both medications should be initiated at lower doses and gradually titrated to minimize adverse effects 6, 2
- For pregabalin, the most common adverse events are somnolence and dizziness, which appear to be dose-related 2
- For gabapentin, starting with 300 mg at bedtime or 100-300 mg three times daily with gradual titration is recommended to minimize side effects 6
- Both medications require dosage adjustments in patients with renal impairment 1
- Lower starting doses and slower titration are recommended in elderly patients 6, 7
Common Pitfalls to Avoid
- Avoid starting at high doses without gradual titration, as this significantly increases the risk of adverse effects 6
- Do not exceed the maximum recommended doses (600 mg/day for pregabalin and 3600 mg/day for gabapentin) 1, 2
- When discontinuing either medication, gradual tapering over at least one week is recommended to minimize withdrawal symptoms 2, 1
- For pregabalin, doses above 450 mg/day may not provide additional anxiolytic benefit but could increase side effects 4, 3
- For gabapentin, doses above 1800 mg/day have not demonstrated additional benefit for anxiety management, though they may be used in certain cases 1