Pregabalin Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Diabetic Neuropathy

Initial dose: 50 mg 3 times a day

The maximum recommended dose is 100 mg 3 times a day in patients with a creatinine clearance of at least 60 mL/min.

The dose may be increased to 100 mg 3 times a day within 1 week based on efficacy and tolerability.

Usual Adult Dose for Postherpetic Neuralgia

Initial dose: 75 mg 2 times a day or 50 mg 3 times a day in patients with a creatinine clearance of at least 60 mL/min

The dose may be increased to 100 mg 3 times a day within 1 week based on efficacy and tolerability.

Maximum dose: Patients who do not experience sufficient pain relief following 2 to 4 weeks of treatment with 300 mg/day and who are able to tolerate pregabalin, may be treated with up to 300 mg 2 times a day or 200 mg 3 times a day. Due to the dose-dependent adverse effects and the higher rate of treatment discontinuation due to adverse events, dosing above 300 mg/day should be reserved only for those patients who have ongoing pain and are tolerating 300 mg daily.

Usual Adult Dose for Epilepsy

Initial dose: 75 mg 2 times a day or 50 mg 3 times a day

Doses of 150 mg to 600 mg/day have been shown to be effective as adjunctive therapy in the treatment of partial onset seizures. The total daily dose should be divided and given either 2 or 3 times a day.

Maximum dose: Based on individual patient response and tolerability, the dose may be increased to a maximum of 600 mg/day.

The efficacy of add-on pregabalin in patients taking gabapentin has not been evaluated in controlled trials. Therefore, dosing recommendations for the use of pregabalin with gabapentin cannot be offered.

Usual Adult Dose for Fibromyalgia

Initial dose: 75 mg two times a day (150 mg/day)

The dose may be increased to 150 mg two times a day (300 mg/day) within one week based on efficacy and tolerability.

Patients who do not experience sufficient benefit with 300 mg/day may be further increased to 225 mg two times a day (450 mg/day).

Recommended dose: 300 to 450 mg/day

Although pregabalin was also studied at 600 mg/day, there is no evidence that this dose confers additional benefit and this dose was less well tolerated. In view of the dose-dependent adverse reactions, treatment with doses above 450 mg/day is not recommended.

Usual Adult Dose for Neuropathic Pain

For neuropathic pain associated with spinal cord injury:

Initial dose: 75 mg 2 times a day

The dose may be increased to 150 mg 2 times a day within 1 week based on efficacy and tolerability.

Doses of 150 mg to 600 mg/day have been shown to be effective as adjunctive therapy in the treatment of neuropathic pain associated with spinal cord injury. The total daily dose should be divided.

Maximum dose: Patients who do not experience sufficient pain relief following 2 to 3 weeks of treatment with 150 mg 2 times a day and who are able to tolerate pregabalin, may be treated with up to 300 mg 2 times a day. Because pregabalin is eliminated primarily by renal excretion, the dose should be adjusted in patients with reduced renal function.

Renal Dose Adjustments

Because pregabalin is eliminated primarily by renal excretion, the dose should be adjusted for patients with reduced renal function. If the CrCl is 30 to 60 mL/min, initiate with 25 mg 3 times a day. If the CrCl is 15 to 30 mL/min, initiate with 25 mg 1 or 2 times a day. If the CrCl is less than 15 mL/min, initiate with 25 mg once a day.

Liver Dose Adjustments

Data not available

Precautions

If pregabalin is to be discontinued, it should be withdrawn gradually over a minimum of one week.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

If the CrCl is less than 15 mL/min then start with 25 mg once a day.

A supplemental dose should be given immediately following every 4 hour hemodialysis treatment. Patients on 25 mg once a day should receive one supplemental dose of 25 mg or 50 mg. Patients on 25 mg to 50 mg once a day should receive one supplemental dose of 50 mg or 75 mg. (Note: While there is an overlap at the 25 mg supplemental dose recommendation, this is how the manufacturer has stated it in the package labeling.) Patients on 75 mg once a day should receive one supplemental dose of 100 mg or 150 mg.

Other Comments

Pregabalin may be given with or without food.

When discontinuing pregabalin, taper gradually over a minimum of 1 week.

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