Maximum Lyrica (Pregabalin) Dosing
The maximum recommended dose of Lyrica (pregabalin) is 600 mg per day, administered in divided doses (either 300 mg twice daily or 200 mg three times daily). 1
FDA-Approved Maximum Dosing by Indication
The FDA label provides specific maximum dosing guidance that varies by clinical indication 1:
Neuropathic pain associated with diabetic peripheral neuropathy: Maximum 300 mg/day (100 mg three times daily). Doses above 300 mg/day are not recommended as they provide no additional significant benefit and are less well tolerated. 1
Postherpetic neuralgia: Maximum 600 mg/day (300 mg twice daily or 200 mg three times daily). Reserve dosing above 300 mg/day only for patients with ongoing pain who tolerate 300 mg daily, after 2-4 weeks of inadequate response at the lower dose. 1
Adjunctive therapy for partial-onset seizures (adults): Maximum 600 mg/day in 2-3 divided doses. 1
Fibromyalgia: Maximum 450 mg/day (225 mg twice daily). 1
Clinical Context from Guidelines
The American College of Cardiology consensus pathway for cardiac amyloidosis confirms the 600 mg/day maximum for neuropathic pain management, specifically noting this should be split twice daily (300 mg BID). 2 This guideline emphasizes the importance of dose adjustment in renal insufficiency and cautions about psychiatric disease or addiction history due to euphoria risk. 2
Critical Dosing Considerations
Renal dose adjustment is mandatory since pregabalin is eliminated primarily by renal excretion. 1 The maximum 600 mg/day dose applies only to patients with creatinine clearance ≥60 mL/min. 1
Titration strategy matters for tolerability: Begin at 150 mg/day and increase to 300 mg/day within 1 week based on efficacy and tolerability. 1 For postherpetic neuralgia specifically, start at 75 mg twice daily (150 mg/day) before advancing to higher doses. 1
Common Pitfall to Avoid
Do not exceed 600 mg/day total daily dose regardless of indication, as higher doses demonstrate dose-dependent adverse reactions with higher treatment discontinuation rates. 2, 1 The evidence shows no additional benefit beyond 600 mg/day for diabetic neuropathy, and this dose was specifically less well tolerated in clinical trials. 1