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Pregabalin Dosage

Medically reviewed on June 26, 2018.

Applies to the following strengths: 25 mg; 50 mg; 75 mg; 100 mg; 150 mg; 200 mg; 300 mg; 225 mg; 20 mg/mL; 82.5 mg; 165 mg; 330 mg

Usual Adult Dose for Diabetic Neuropathy

Immediate-release:
Initial dose: 50 mg orally 3 times a day
-Dose may be increased to 100 mg orally 3 times a day within 1 week based on efficacy and tolerability
Maximum dose: 300 mg per day

Extended-release:
Initial dose: 165 mg orally once a day after the evening meal
-Dose may be increased to 330 mg orally once a day within 1 week based on efficacy and tolerability
Maximum dose: 330 mg per day

Conversion from Immediate-release to Extended-release:
-On the day of the switch, patient should take their morning dose of immediate release pregabalin as prescribed and initiate extended-release therapy after the evening meal. See dose adjustment section for equivalent doses.

Comment:
-Doses of 600 mg per day have been studied and do not appear to confer additional significant benefit; treatment with doses above 300 mg per day (immediate-release) or 330 mg per day (extended-release) are not recommended due to dose-dependent adverse reactions.

Use: Management of neuropathic pain associated with diabetic peripheral neuropathy

Usual Adult Dose for Postherpetic Neuralgia

Immediate-release:
Initial dose: 150 to 300 mg orally per day in 2 or 3 divided doses
-Dose may be increased to 300 per day in 2 or 3 divided doses within 1 week based on efficacy and tolerability
-If, after 2 to 4 weeks of therapy at 300 mg per day, there is insufficient pain relief and patient is tolerating therapy, dose may be increased up to 600 mg per day in 2 or 3 divided doses
Maximum dose: 600 mg per day

Extended-release:
Initial dose: 165 mg orally once a day after the evening meal
-Dose may be increased to 330 mg orally once a day within 1 week based on efficacy and tolerability
-If, after 2 to 4 weeks of therapy at 330 mg per day, there is insufficient pain relief and patient is tolerating therapy, dose may be increased up to 660 mg per day
Maximum dose: 660 mg per day

Conversion from Immediate-release to Extended-release:
-On the day of the switch, patient should take their morning dose of immediate release pregabalin as prescribed and initiate extended-release therapy after the evening meal. See dose adjustment section for equivalent doses.

Comment:
-Treatment with doses above 300 mg per day (immediate-release) or 330 mg per day (extended-release) should be reserved for patients with on-going pain who have demonstrated tolerability at lower doses due to the high rate of discontinuation from adverse reactions at higher doses.

Use: Management of postherpetic neuralgia

Usual Adult Dose for Epilepsy

Initial dose: 150 mg orally per day in 2 or 3 divided doses
-Dose may be increased weekly based on clinical response and tolerability
Maintenance dose: 150 to 600 mg per day in divided doses 2 or 3 times a day
Maximum dose: 600 mg per day

Comments:
-Both the efficacy and adverse event profile of this drug have been shown to be dose dependent; the effect of dose escalation on the tolerability of this drug has not been formally studied.
-The efficacy of add-on therapy in patients taking gabapentin has not been evaluated in controlled trials; therefore, dosing recommendations for the use of this combination cannot be offered.

Use: Adjunctive therapy for treatment of partial onset seizures

Usual Adult Dose for Fibromyalgia

Initial dose: 75 mg orally twice a day
-Increase dose to 150 mg orally twice a day within 1 week based on efficacy and tolerability; the dose may be further increased to 225 mg orally twice a day
Maintenance dose: 300 to 450 mg per day in divided doses
Maximum dose: 450 mg per day

Comments:
-This drug has been studied at 600 mg per day. There was no evidence of additional benefit and this dose was less well tolerated. Due to dose-dependent adverse reactions, treatment with doses above 450 mg per day is not recommended.

Use: Management of fibromyalgia

Usual Adult Dose for Neuropathic Pain

Initial dose: 75 mg orally twice a day
-Increase dose to 150 mg orally twice a day within 1 week based on efficacy and tolerability; for patients with insufficient pain relief after 2 to 3 weeks at this dose and who are tolerating therapy, dose may be increased up to 300 mg orally 2 times a day
Maintenance dose: 150 to 600 mg per day in divided doses
Maximum dose: 600 mg per day

Use: Management of neuropathic pain associated with spinal cord injury

Usual Pediatric Dose for Epilepsy

Age: 4 years or older:
-Weight 11 kg to less than 30 kg:
Initial dose: 3.5 mg/kg orally per day in 2 or 3 divided doses
Maintenance dose: 3.5 to 14 mg/kg per day in divided doses 2 or 3 times a day

-Weight 30 kg or greater:
Initial dose: 2.5 mg/kg orally per day in 2 or 3 divided doses
Maintenance dose: 2.5 to 10 mg/kg per day in divided doses 2 or 3 times a day
Maximum dose: 600 mg per day

17 years or older:
Initial dose: 150 mg orally per day in 2 or 3 divided doses
Maintenance dose: 150 to 600 mg per day in divided doses 2 or 3 times a day
Maximum dose: 600 mg per day

Comments:
-Doses may be increased weekly based on clinical response and tolerability.
-Both the efficacy and adverse event profile of this drug have been shown to be dose dependent; the effect of dose escalation on the tolerability of this drug has not been formally studied.
-The efficacy of add-on therapy in patients taking gabapentin has not been evaluated in controlled trials; therefore, dosing recommendations for the use of this combination cannot be offered.

Use: Adjunctive therapy for treatment of partial onset seizures

Renal Dose Adjustments

Immediate-release:
ADULTS:
-CrCl 60 mL/min or greater: No adjustment recommended
-CrCl 30 to 60 mL/min: Reduce dose by 50%; dose range: 75 to 300 mg per day in 2 or 3 divided doses
-CrCl 15 to 30 mL/min: Reduce dose by approximately 75%; dose range: 25 to 150 mg orally per day in 1 to 2 divided doses
-CrCl less than 15 mL/min: Reduce dose by approximately 87.5%; dose range: 25 to 75 mg per day
See dialysis section for supplemental dose recommendations
PEDIATRICS: The use of this drug in patients with renal impairment has not been studied.

Extended-release:
-CrCl 60 mL/min or greater: No adjustment recommended
-CrCl 30 to 60 mL/min: Reduce dose by 50%; dose range 82.5 to 330 mg per day
-CrCl less than 30 mL/min: Not recommended; use immediate-release formulation

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

Elderly: Dose should be adjusted based on renal function; as this drug is known to be substantially excreted by the kidney, renal function monitoring is recommended.

Conversion from Immediate-release (IR) to Extended-release (CR):
-On the day of the switch, patient should take their morning dose of immediate release pregabalin as prescribed and initiate extended-release therapy after the evening meal:
--For IR total daily dose of 75 mg: CR dose is 82.5 mg/day
--For IR total daily dose of 150 mg: CR dose is 165 mg/day
--For IR total daily dose of 225 mg: CR dose is 247.5 mg/day
--For IR total daily dose of 300 mg: CR dose is 330 mg/day
--For IR total daily dose of 450 mg: CR dose is 495 mg/day
--For IR total daily dose of 600 mg: CR dose is 660 mg/day

Extended-release (CR) tablets are only approved for neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia.

Precautions

Safety and efficacy of immediate-release in patients with partial onset seizures have not been established in patients younger than 4 years.
Safety and efficacy of immediate-release in patients with fibromyalgia, neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, and neuropathic pain associated with spinal cord injury have not been established in patients younger than 18 years.
Safety and efficacy of controlled-release have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule V

Dialysis

Immediate-release formulation only:
For patients undergoing hemodialysis, adjust the daily dose based on renal function; in addition to the daily dose adjustment, administer a supplemental dose immediately following every 4-hour hemodialysis treatment:
-Patients on the 25 mg/day regimen: take one supplemental dose of 25 mg or 50 mg
-Patients on the 25 to 50 mg/day regimen: take one supplemental dose of 50 mg or 75 mg
-Patients on the 50 to 75 mg/day regimen: take one supplemental dose of 75 mg or 100 mg
-Patients on the 75 mg/day regimen: take one supplemental dose of 100 mg or 150 mg

Other Comments

Administration advice:
Immediate-release:
-Take orally with or without food
-Missed dose: The missed dose should be taken as soon as remembered unless it is time for the next dose, if it is time for the next dose, they should skip the missed dose and take the next dose at the regularly scheduled time; they should not take 2 doses at the same time.

Extended-release:
-Swallow whole; do not split, crush or chew
-Take at the same time each day, preferably after evening meal
-Missed dose: If a dose is missed after the evening meal, take at bedtime following a snack; if the evening dose is missed until the following morning, take the missed dose following the morning meal. If they miss taking the dose with the morning meal, they should wait and take their usual dose at the usual time following the evening meal.

General:
-Discontinuation of therapy should be gradual, over a minimum of 1 week.

Patient Advice:
-Read the US FDA-approved patient labeling (Patient Information and Instructions for Use).
-This drug may cause drowsiness; avoid driving or operating machinery if you feel drowsy or dizzy.
-Avoid alcohol as this may potentiate the impairment of motor skills and sedating effects of alcohol.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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