Duration of Pregabalin Treatment for Postherpetic Neuralgia
Pregabalin should be continued as long as it provides meaningful pain relief, with periodic reassessment to determine if ongoing therapy remains necessary, as postherpetic neuralgia may improve over time. 1
Evidence for Treatment Duration
The clinical trial evidence demonstrates sustained efficacy throughout study periods, but does not establish a specific endpoint for discontinuation:
Clinical trials evaluated pregabalin for 4-13 weeks, with the longest double-blind study extending to 13 weeks, showing maintained efficacy throughout the entire treatment period 2, 3
Pain relief onset occurs rapidly (median 1.5-3.5 days with pregabalin versus >4 weeks with placebo), and this benefit is sustained for the duration of treatment studied 2
A 13-week randomized withdrawal trial demonstrated that patients who achieved ≥50% pain reduction during a 6-week single-blind phase and were then randomized to continue pregabalin had significantly fewer loss of therapeutic response events (13.9%) compared to those switched to placebo (30.7%), indicating that discontinuation leads to symptom recurrence 4
Practical Treatment Approach
Initial trial period:
- Allow 3-8 weeks for dose titration plus 2 weeks at maximum tolerated dose to properly assess efficacy 5
- Effective doses typically range from 150-600 mg/day in two divided doses 1, 2
Ongoing management:
- Continue treatment indefinitely as long as meaningful pain relief persists 1
- Conduct periodic reassessments (every 3-6 months is reasonable based on clinical judgment) to evaluate whether pain has improved sufficiently to attempt dose reduction or discontinuation 1
- Consider gradual taper rather than abrupt discontinuation if attempting to stop therapy 4
Important Considerations
No maximum duration is specified in guidelines because postherpetic neuralgia is a chronic condition that may persist for months to years, and some patients require long-term treatment 6
Natural history matters: Postherpetic neuralgia can spontaneously improve over time in some patients, making periodic reassessment essential to avoid unnecessary long-term medication use 1
Pregabalin is FDA-approved for postherpetic neuralgia, supporting its use for chronic treatment when clinically indicated 6