Maximum Dose of Lyrica (Pregabalin)
The maximum recommended dose of pregabalin is 600 mg per day, administered in two or three divided doses. 1
FDA-Approved Maximum Dosing by Indication
The FDA label provides specific maximum dosing guidance that varies by condition:
Postherpetic Neuralgia: Maximum 600 mg/day (300 mg twice daily or 200 mg three times daily) 1
Diabetic Peripheral Neuropathy: Maximum 300 mg/day (100 mg three times daily) 1
Fibromyalgia: Maximum 450 mg/day (though some sources cite 600 mg/day as absolute maximum) 1, 2
- Recommended range is 300-450 mg/day 1
Partial-Onset Seizures (adjunctive therapy): Maximum 600 mg/day 1
Critical Dosing Considerations
Renal Impairment Requires Mandatory Dose Reduction:
- Pregabalin is eliminated primarily by renal excretion 1, 2
- Dose reductions of approximately 50% for CrCl 30-60 mL/min, 75% for CrCl 15-30 mL/min, and 85-90% for CrCl <15 mL/min 2
Elderly Patients:
- Lower starting doses and slower titration are strongly recommended due to increased risk of dizziness, somnolence, confusion, and falls 2, 1
Common Pitfalls to Avoid
Do not exceed 600 mg/day under any circumstances - this is the absolute maximum dose across all indications, and higher doses increase adverse effects without additional benefit 1, 2
Do not use 600 mg/day for diabetic neuropathy - the FDA specifically recommends against this due to lack of additional efficacy and poor tolerability 1
Avoid abrupt discontinuation - taper gradually over a minimum of 1 week to prevent withdrawal symptoms 1, 2
Dose-Dependent Adverse Effects
Common side effects increase with dose and include:
- Dizziness (23-46%) 2
- Somnolence (15-25%) 2
- Peripheral edema (10%) 2
- Treatment discontinuation rates of 18-28% at 600 mg/day 3
Safety Warning
Serious breathing problems can occur when pregabalin is combined with opioids, benzodiazepines, or other CNS depressants - use extreme caution with these combinations 2