What is the recommended dosage of pregabalin (Lyrica)?

From the Guidelines

Pregabalin is recommended to be started at a dosage of 50 mg 3 times daily or 75 mg twice daily, with a maximum dosage of 600 mg/d (200 mg 3 times daily) or 300 mg twice daily, as tolerated, with adjustments for impaired renal function. The dosage can be increased to 300 mg/d after 3-7 days, then by 150 mg/d every 3-7 days as tolerated 1. It is essential to consider lower starting dosages and slower titration in geriatric patients. Key points to consider when prescribing pregabalin include:

• Starting dosage: 50 mg 3 times daily or 75 mg twice daily
• Titration: Increase to 300 mg/d after 3-7 days, then by 150 mg/d every 3-7 days as tolerated
• Maximum dosage: 600 mg/d (200 mg 3 times daily) or 300 mg twice daily
• Duration of adequate trial: 4 weeks
• Renal function: Reduce dosage if impaired renal function is present, as pregabalin has linear pharmacokinetics and dosing is more straightforward 1. Pregabalin may provide analgesia more quickly than gabapentin because the initial dosage has been found to be efficacious in some trials, and the time required to titrate to a full dosage is less 1. Common side effects include dizziness, drowsiness, dry mouth, and weight gain, which may be minimized by starting at a lower dose and gradually increasing. When discontinuing pregabalin, the dose should be tapered gradually over at least one week to avoid withdrawal symptoms.

From the FDA Drug Label

2.2 Neuropathic Pain Associated with Diabetic Peripheral Neuropathy in Adults The maximum recommended dose of pregabalin is 100 mg three times a day (300 mg/day) in patients with creatinine clearance of at least 60 mL/min.

2.3 Postherpetic Neuralgia in Adults The recommended dose of pregabalin is 75 to 150 mg two times a day, or 50 to 100 mg three times a day (150 to 300 mg/day) in patients with creatinine clearance of at least 60 mL/min.

2.4 Adjunctive Therapy for Partial-Onset Seizures in Patients 1 Month of Age and Older The recommended dosages for adults and pediatric patients 1 month of age and older are included in Table 1.

2.5 Management of Fibromyalgia in Adults The recommended dose of pregabalin for fibromyalgia is 300 to 450 mg/day.

The recommended dosage of pregabalin (Lyrica) varies by indication:

• Neuropathic Pain Associated with Diabetic Peripheral Neuropathy: 100 mg three times a day (300 mg/day)
• Postherpetic Neuralgia: 75 to 150 mg two times a day, or 50 to 100 mg three times a day (150 to 300 mg/day)
• Adjunctive Therapy for Partial-Onset Seizures: dosages are included in Table 1, with a maximum of 600 mg/day for adults
• Management of Fibromyalgia: 300 to 450 mg/day 2

From the Research

Recommended Dosage of Pregabalin

The recommended dosage of pregabalin (Lyrica) varies depending on the condition being treated and the patient's response to the medication.

• For neuropathic pain, the initial recommended dose is 150 mg per day, which can be increased up to 300 mg per day (divided into 2-3 daily doses) during a one-week period 3.
• In patients with diabetic peripheral neuropathy, a significant difference between placebo and treatment group was only achieved with daily doses of 300 mg/day, and the response was clearly dose-dependent 3.
• The starting dosage for patients with neuropathic pain associated with diabetic peripheral neuropathy is 50 mg three times daily and may be increased to 300 mg daily within one week based on efficacy and tolerability 4.
• For patients with spinal cord injury, dosing is typically initiated at 150 mg/day in divided doses, but may be started at even lower doses, and can be increased gradually to a recommended maximum of 600 mg per day in divided dosing 5.
• In a study evaluating the efficacy and safety of a fixed-dose combination of low-dose pregabalin and duloxetine, or pregabalin monotherapy for neuropathic pain, pregabalin was initiated at 75mg/day and gradually titrated to a maximum of 150mg twice daily 6.
• A 12-week randomised, double-blind, multicentre, placebo-controlled study evaluated the efficacy and safety of pregabalin in patients with chronic postherpetic neuralgia (PHN) or painful diabetic peripheral neuropathy (DPN), with patients randomised to a flexible schedule of 150,300,450, and 600 mg/day with weekly dose escalation based on patients' individual responses and tolerability, or a fixed schedule of 300 mg/day for 1 week followed by 600 mg/day for 11 weeks 7.

Dosage Titration

Dosage titration is important to achieve optimal balance of efficacy and tolerability, and to reduce risks for adverse events and therapy discontinuation.

• The dosage can be increased gradually based on the patient's response and tolerability 3, 4, 5, 6, 7.
• The most common adverse events for pregabalin-treated patients were dizziness, peripheral oedema, weight gain, and somnolence, which can be managed by a simple dose reduction, with no need to discontinue the therapy 3, 4, 6, 7.