Maximum Dose of Pregabalin
The maximum dose of pregabalin is 600 mg per day, typically divided into 2-3 doses daily.
Dosing Framework
Standard Maximum Dose
- 600 mg/day is the established maximum dose for adults across all approved indications including neuropathic pain, postherpetic neuralgia, diabetic peripheral neuropathy, and adjunctive epilepsy treatment 1.
- This can be administered as either 200 mg three times daily or 300 mg twice daily 1.
Titration to Maximum Dose
- Start at 150 mg/day (50 mg three times daily or 75 mg twice daily) 1.
- Increase to 300 mg/day after 3-7 days, then by 150 mg/day every 3-7 days as tolerated 1.
- The maximum 600 mg/day dose should be reached through gradual titration over approximately 1-4 weeks 1.
Important Clinical Considerations
Efficacy vs. Tolerability Trade-off
- Doses above 300 mg/day are not consistently more effective than 300 mg/day but are associated with greater rates of adverse effects 1.
- Many patients achieve adequate pain relief at 300 mg/day without requiring dose escalation 1.
- The dose-response relationship shows diminishing returns above 300 mg/day 1.
Renal Impairment
- Dose reduction is mandatory in patients with renal insufficiency as pregabalin is eliminated 98% unchanged by renal excretion 1.
- Dosage adjustments should be made in relation to creatinine clearance 1.
Elderly and Medically Frail Patients
- Slower titration is recommended for elderly or medically frail patients 1.
- Consider lower starting dosages and more gradual increases in geriatric populations 1.
Pediatric Dosing
- For children 4 to <17 years: Maximum 600 mg/day or 10 mg/kg/day, whichever is lower 2.
- For children 1 month to <4 years: Maximum 14 mg/kg/day divided three times daily 2.
- Weight-based adjustments are required for children <30 kg 2.
Common Pitfalls to Avoid
Exceeding 600 mg/day
- Never exceed 600 mg/day in adults as this is the FDA-approved maximum dose with no evidence of additional benefit 1, 2.
- Higher doses only increase the risk of dose-dependent adverse effects including dizziness, somnolence, peripheral edema, and weight gain 1.
Rapid Titration
- Avoid rapid dose escalation as this increases the likelihood of intolerable side effects, particularly dizziness and sedation 1.
- Gradual titration over 1 week minimum allows for better tolerability 1.
Failure to Adjust for Renal Function
- Always check renal function before prescribing and adjust doses accordingly 1.
- Even moderate renal impairment (creatinine clearance <60 mL/min) requires dose reduction 3.
Abrupt Discontinuation
- Pregabalin should be tapered when discontinuing treatment to avoid withdrawal symptoms 1.