Recommended Dosing of Pregabalin (Lyrica) for Anxiety
The recommended dose of pregabalin (Lyrica) for treating anxiety is 150-600 mg/day, typically starting at 150 mg/day divided into two or three doses, with gradual titration based on response and tolerability. 1, 2
Initial Dosing and Titration
- Start with 150 mg/day divided into two doses (75 mg twice daily) 3, 2
- After one week, if needed and tolerated, increase to 300 mg/day (150 mg twice daily) 3, 4
- Further dose increases should be made in increments of 150 mg/day every 3-7 days as needed and tolerated 3
- Maximum recommended dose is 600 mg/day (300 mg twice daily) 3, 1
Special Populations
- For elderly patients (≥65 years), consider starting at a lower dose of 75 mg/day and titrate more slowly 5
- Reduce dosage in patients with impaired renal function 3
- For patients with severe anxiety, doses of 450-600 mg/day may be required 4
Efficacy Considerations
- Pregabalin shows rapid onset of anxiolytic effect, often within the first week of treatment 1, 2
- Efficacy has been demonstrated across the 150-600 mg/day dose range 4
- The magnitude of anxiolytic effect is comparable to benzodiazepines like lorazepam but without the same risk of dependence 1, 2
- Pregabalin demonstrates efficacy for both psychic and somatic symptoms of anxiety 2, 5
Safety and Tolerability
- Most common adverse effects are dizziness (up to 49%) and somnolence (up to 50%) 6
- Side effects are typically dose-related and often transient, resolving within a few weeks 2
- Unlike benzodiazepines, pregabalin does not appear to cause significant withdrawal symptoms when discontinued, though tapering over at least one week is recommended 4
- Pregabalin shows less cognitive and psychomotor impairment compared to benzodiazepines 2
Treatment Duration
- For acute anxiety, a 4-8 week treatment course has shown efficacy 2
- Long-term studies (26 weeks) have demonstrated maintained anxiolytic effects 2
- After 9 months of treatment, consider dose reduction to reassess continued need 3
Common Pitfalls and Caveats
- Pregabalin is primarily FDA-approved for neuropathic pain conditions and seizures in the US, though it has shown efficacy for anxiety disorders 6
- Do not abruptly discontinue pregabalin; taper gradually over at least one week to minimize potential withdrawal effects 4
- Monitor for excessive sedation, especially when initiating therapy or increasing doses 6
- Be aware that pregabalin is classified as a Schedule V controlled substance in the US due to potential for abuse 3
- Avoid use with CNS depressants like benzodiazepines without appropriate dose adjustments, as this may increase sedation risk 2