What is the recommended dosage of pregabalin (Lyrica) by age?

Pregabalin Age-Associated Dosage

Standard Adult Dosing (Ages 17 and Older)

For adults under 65 years, pregabalin dosing is indication-specific and does not vary by age within this range, with starting doses of 75-150 mg/day and maximum doses of 300-600 mg/day depending on the condition being treated. 1

Neuropathic Pain Associated with Diabetic Peripheral Neuropathy

• Starting dose: 50 mg three times daily (150 mg/day) 1
• Target dose: 100 mg three times daily (300 mg/day) within 1 week based on efficacy and tolerability 1
• Maximum dose: 300 mg/day (doses above this are not recommended due to lack of additional benefit and increased adverse effects) 1

Postherpetic Neuralgia

• Starting dose: 75 mg twice daily or 50 mg three times daily (150 mg/day) 1
• Target dose: 150 mg twice daily or 100 mg three times daily (300 mg/day) within 1 week 1, 2
• Maximum dose: 300 mg twice daily or 200 mg three times daily (600 mg/day) for patients with inadequate pain relief after 2-4 weeks on 300 mg/day who tolerate the medication well 1, 2
• Reserve doses above 300 mg/day only for patients with ongoing pain who tolerate the 300 mg dose 2, 1

Fibromyalgia

• Starting dose: 75 mg twice daily (150 mg/day) 1
• Target dose: 150 mg twice daily (300 mg/day) within 1 week 1
• Maximum dose: 225 mg twice daily (450 mg/day) for patients without sufficient benefit at 300 mg/day 1
• Doses above 450 mg/day are not recommended due to lack of additional benefit and increased adverse effects 1

Neuropathic Pain Associated with Spinal Cord Injury

• Starting dose: 75 mg twice daily (150 mg/day) 1
• Titration: Increase to 150 mg twice daily (300 mg/day) within 1 week 1
• Maximum dose: 300 mg twice daily (600 mg/day) for patients without sufficient pain relief after 2-3 weeks at 300 mg/day who tolerate pregabalin 1

Partial-Onset Seizures (Adults)

• Starting dose: 150 mg/day 1
• Maximum dose: 600 mg/day administered in 2 or 3 divided doses 1

Elderly Patients (Ages 65 and Older)

Elderly patients require lower starting doses and slower titration due to increased risk of adverse effects including dizziness, somnolence, confusion, balance disorder, tremor, coordination abnormalities, and lethargy. 2, 1

Key Considerations for Elderly Patients

• Mandatory dose adjustment is required based on renal function, as pregabalin is eliminated primarily by renal excretion and elderly patients often have decreased creatinine clearance 1, 2
• Start at the lower end of the dosing range (e.g., 50 mg twice daily or 75 mg once daily at bedtime) 2
• Implement slower dose escalation with adequate intervals (weekly or longer) to monitor effects 2
• The risk of toxic reactions is greater in elderly patients with impaired renal function 1

Dose Adjustment for Renal Impairment in Adults

Pregabalin dosing must be adjusted based on creatinine clearance (CLcr) 1:

• CLcr ≥60 mL/min: Standard dosing as above 1
• CLcr 30-60 mL/min: Reduce total daily dose by approximately 50% 2
• CLcr 15-30 mL/min: Reduce total daily dose by approximately 75% 2
• CLcr <15 mL/min: Reduce total daily dose by approximately 85-90% 2

Pediatric Dosing (Partial-Onset Seizures Only)

Pregabalin is NOT approved for neuropathic pain, fibromyalgia, or other indications in pediatric patients; it is only indicated for partial-onset seizures in patients 1 month of age and older. 1

Pediatric Patients Weighing 30 kg or More

• Starting dose: 2.5 mg/kg/day 1
• Maximum dose: 10 mg/kg/day (not to exceed 600 mg/day) 1
• Frequency: 2 or 3 divided doses 1

Pediatric Patients Weighing Less Than 30 kg

• Starting dose: 3.5 mg/kg/day 1
• Maximum dose: 14 mg/kg/day 1
• Frequency:
  • Ages 1 month to <4 years: 3 divided doses 1
  • Ages 4 years and older: 2 or 3 divided doses 1

Critical Administration Principles Across All Ages

• Administer with or without food (food has no clinically relevant effect on absorption) 1, 3
• Divide total daily dose into 2-3 administrations per day 1
• Taper gradually over a minimum of 1 week when discontinuing to avoid withdrawal symptoms 1, 2
• Steady state is achieved within 24-48 hours 3
• Time to peak concentration is approximately 1 hour 3
• Bioavailability is high (>90%) and dose-proportional 3

Common Pitfalls to Avoid

• Do not exceed maximum recommended doses as higher doses increase adverse effects without additional benefit 1, 2
• Do not use once-daily dosing for standard pregabalin formulations; 2-3 times daily administration is required 2
• Do not rush titration in elderly patients as this increases fall risk from dizziness 2
• Do not forget renal dose adjustment in elderly patients, as pregabalin is 98% renally excreted 1, 2
• Do not abruptly discontinue without tapering over at least 1 week 1, 2