How do you titrate up Pregabalin (Lyrica) 165MG Oral Tablet, Extended Release?

Pregabalin 165MG Extended Release Tablet Titration Protocol

For pregabalin extended release 165mg tablets, start with one tablet daily and increase by one tablet every 7 days as tolerated, with a maximum recommended dose of 330mg daily (two 165mg tablets). 1

Initial Dosing and Titration Schedule

• Start with pregabalin ER 165mg once daily 1
• After 7 days, if tolerated but inadequate response, increase to 330mg once daily (maximum recommended dose) 1, 2
• Take at approximately the same time each day, with or without food 3

Monitoring During Titration

• Monitor for common adverse effects during titration, including:
  • Dizziness and somnolence (most common side effects) 4, 5
  • Peripheral edema 5
  • Mental confusion, particularly in elderly patients 1
• Adverse effects are typically dose-dependent and can often be managed with dose reduction rather than discontinuation 5

Special Considerations

• For patients with renal impairment, dose adjustment is necessary as pregabalin is primarily excreted unchanged by the kidneys 1, 6
• For elderly patients, consider a more gradual titration approach due to increased sensitivity to adverse effects 1, 7
• Pregabalin has linear pharmacokinetics, making dosing more predictable compared to gabapentin 1, 6

Efficacy Assessment

• An adequate trial of pregabalin requires approximately 4 weeks to properly evaluate efficacy 1, 7
• Some patients may experience improvement as early as week 1, which may persist throughout treatment 3
• If inadequate response at maximum dose of 330mg daily after 4 weeks, consider alternative treatment options 1, 2

Common Pitfalls to Avoid

• Avoid rapid titration, as this increases the risk of adverse effects; follow the "low and slow" approach 7
• Avoid abrupt discontinuation in patients who have been on high doses for extended periods to prevent withdrawal symptoms 8
• Do not exceed the maximum recommended dose of 330mg daily for the extended-release formulation 2
• Remember that higher doses (>300mg/day) are not consistently more effective but have more adverse effects 1

If Discontinuation is Needed

• Implement a gradual tapering schedule rather than abrupt discontinuation 8
• Consider reducing dose by approximately 25% per week (e.g., from 330mg to 165mg for one week before stopping) 8
• Monitor for withdrawal symptoms such as headache, nausea, and dizziness during the tapering process 8