What are the proper dosing instructions for Maxgalin ER 75 (Pregabalin)?

Maxgalin ER 75 (Pregabalin) Dosing Instructions

For neuropathic pain, start Maxgalin ER 75 mg twice daily (150 mg/day total), then increase to 150 mg twice daily (300 mg/day) after 4-7 days based on efficacy and tolerability, with a maximum dose of 300 mg twice daily (600 mg/day). 1

Initial Dosing

• Starting dose: 75 mg twice daily (150 mg/day total) 1
• Begin at bedtime if sedation is a concern, then add morning dose after 2-3 days 1
• For elderly or medically frail patients, consider starting at 50 mg three times daily (150 mg/day) with slower titration 1

Titration Schedule

• Week 1: After 4-7 days at starting dose, increase to 150 mg twice daily (300 mg/day total) 1
• Week 2-3: If pain relief is inadequate but tolerability is good, increase to 225 mg twice daily (450 mg/day) 1
• Week 3-4: May further increase to maximum of 300 mg twice daily (600 mg/day) if needed 1
• Dose increments should be 50-100% every few days for standard patients 1

Maximum Dosing

• Absolute maximum: 600 mg/day in divided doses (either 300 mg twice daily or 200 mg three times daily) 1, 2
• Higher doses beyond 600 mg/day are not consistently more effective 1

Special Population Adjustments

Renal Insufficiency

• Critical: Dose adjustment is mandatory in patients with kidney disease 1
• Reduce both starting dose and maximum dose based on creatinine clearance 1
• Monitor renal function before initiating and periodically during treatment 1

Elderly Patients

• Start at lower doses (50 mg three times daily or 75 mg twice daily) 1
• Use slower titration schedule, extending each step to 2 weeks instead of 1 week 3
• Higher risk of sedation, dizziness, and confusion 1

Efficacy Timeline

• Adequate trial duration: 4-6 weeks total, including at least 2 weeks at maximum tolerated dose 1
• If less than 5% weight loss or inadequate pain relief at 12 weeks, discontinue and consider alternative 1
• Most patients who respond will show improvement within 2-4 weeks at therapeutic doses 1

Common Adverse Effects to Monitor

• Somnolence: Occurs in 11-25% depending on dose 1, 2
• Dizziness: Occurs in 13-35% depending on dose 1, 2
• Peripheral edema: Monitor for weight gain and swelling 1
• Confusion and cognitive impairment: Especially in elderly 1

Discontinuation Protocol

Never stop pregabalin abruptly - taper gradually to avoid withdrawal symptoms 3

Recommended Tapering from 300 mg/day:

• Week 1: Reduce to 225 mg/day (75 mg three times daily) 3
• Week 2: Reduce to 150 mg/day (50 mg three times daily) 3
• Week 3: Reduce to 75 mg/day (25 mg three times daily) 3
• Week 4: Discontinue 3

If Withdrawal Symptoms Occur:

• Slow the taper by extending each step to 2 weeks instead of 1 week 3
• Monitor for headache, nausea, dizziness, and return of pain 3

Critical Contraindications and Precautions

• Psychiatric disease or addiction history: Risk of euphoria and abuse potential (Schedule V controlled substance) 1, 4
• Cardiac disease: Use with caution, though less concerning than with sympathomimetic agents 1
• Pregnancy: Avoid use 1
• Concomitant CNS depressants: Increased risk of sedation 1

Common Pitfalls to Avoid

• Inadequate trial duration: Many clinicians discontinue too early; allow full 4-6 weeks at therapeutic dose 1
• Insufficient dose escalation: Starting at 150 mg/day is often ineffective; most patients require 300-600 mg/day 2, 5
• Forgetting renal adjustment: Failure to reduce dose in renal insufficiency leads to toxicity 1
• Abrupt discontinuation: Always taper to prevent withdrawal syndrome 3