From the Guidelines
The upper limit of pregabalin dosing per day is 600 mg, which can be divided into two or three equal doses, as indicated in the most recent and highest quality study available 1. When considering the dosing of pregabalin, it's crucial to prioritize the patient's renal function, as impaired renal function necessitates dose reduction to prevent adverse effects.
- The recommended starting dose is 50 mg three times daily or 75 mg twice daily, with gradual titration to the maximum dose based on efficacy and tolerability.
- Patients with severe renal impairment (creatinine clearance <15 mL/min) should not exceed 150 mg daily, highlighting the importance of renal function in determining the safe upper limit of pregabalin dosing.
- The linear pharmacokinetics of pregabalin allow for more straightforward dosing compared to other medications like gabapentin, but it's essential to monitor for dose-limiting adverse effects.
- Exceeding the recommended maximum dose of 600 mg per day does not provide additional therapeutic benefit and increases the risk of adverse effects such as dizziness, somnolence, and cognitive impairment, as noted in the study 1. The study 1 emphasizes the importance of careful dose titration and monitoring to ensure the safe and effective use of pregabalin, particularly in patients with renal impairment or other comorbidities.
From the FDA Drug Label
2.2 Neuropathic Pain Associated with Diabetic Peripheral Neuropathy in Adults The maximum recommended dose of pregabalin is 100 mg three times a day (300 mg/day) in patients with creatinine clearance of at least 60 mL/min.
2.3 Postherpetic Neuralgia in Adults ...may be treated with up to 300 mg two times a day, or 200 mg three times a day (600 mg/day)
2.4 Adjunctive Therapy for Partial-Onset Seizures in Patients 1 Month of Age and Older ...Recommended Maximum Dosage ... 600 mg/day
2.5 Management of Fibromyalgia in Adults The recommended dose of pregabalin for fibromyalgia is 300 to 450 mg/day.
The upper limit of pregabalin dosing per day is 600 mg/day in certain conditions, as seen in postherpetic neuralgia and adjunctive therapy for partial-onset seizures, but the maximum recommended dose is 300 mg/day for neuropathic pain associated with diabetic peripheral neuropathy and 450 mg/day for fibromyalgia 2.
From the Research
Pregabalin Dosing
The upper limit of pregabalin dosing per day is a crucial aspect of its administration. According to the available evidence:
- The recommended maximum dose of pregabalin is 600 mg per day in divided dosing 3.
- Dosing can be increased gradually to this maximum, with some studies suggesting that higher doses may be more effective in improving pain outcomes 4.
- However, it is essential to consider the patient's renal function when determining the dose, as pregabalin clearance is proportional to creatinine clearance (CLcr) 5.
- For patients with CLcr between 30 and 60 mL/min, a 50% reduction in pregabalin daily dose is recommended compared to those with CLcr > 60 mL/min 5.
- Daily doses should be further reduced by approximately 50% for each additional 50% decrease in CLcr 5.
Key Considerations
When determining the upper limit of pregabalin dosing per day, the following factors should be considered:
- Renal function: Pregabalin dosage adjustment should be considered for patients with CLcr < 60 mL/min 5.
- Pain outcomes: Higher doses of pregabalin may be more effective in improving pain outcomes, but may also increase the risk of adverse effects 4.
- Adverse effects: Common adverse effects of pregabalin include somnolence, dizziness, and dry mouth, which typically manifest within the first 2 weeks of treatment 3.