Pregabalin Review – Dosing Information
This information has been produced to assist practices who are reviewing pregabalin
as part of the Incentive Scheme
Switching pregabalin to gabapentin in patients with normal renal
function
This would be a straight switch, rather than titrating down the pregabalin dose and
titrating up the gabapentin dose.
Pregabalin total daily
dose pre-switch
150mg
225mg
300mg
450mg
600mg
Gabapentin total daily dose
post switch (Toth study9)
900mg
901mg to 1500mg
1501mg to 2100mg
2101mg to 2700mg
2701mg to 3600mg
Suggested daily dose of
gabapentin
300mg tds
400mg tds
2x300mg tds
2x400mg tds
3x300mg tds
For daily doses of pregabalin below 150mg daily, e.g. 100mg, 75mg – switch to
gabapentin 100mg tds, and titrate up if necessary (see gabapentin titration schedule
below on p2).
Gabapentin dose adjustment based on renal function
Creatinine Clearance
(ml/min) or eGFR
Total Daily Dose
(mg/day)
≥80
900-3600
50-79
600-1800
30-49
300-900
15-29
*150-600
<15**
*
150 -300
*To be administered as 300 mg every other day.
** For patients with creatinine clearance <15
ml/min, the daily dose should be reduced in
proportion to creatinine clearance (e.g., patients
with a creatinine clearance of 7.5 ml/min should
receive one-half the daily dose that patients with a
creatinine clearance of 15 ml/min receive).
Gabapentin 100 mg capsules can be used to
follow dosing recommendations for patients with
renal insufficiency
Discontinuing gabapentin
If gabapentin has to be discontinued it is recommended this should be done gradually
over a minimum of 1 week (SPC).
Stepping down and discontinuing pregabalin
The SPC for Lyrica states that pregabalin should be discontinued gradually over at
least one week, independent of the indication.
Prescribing incentive scheme: Pregabalin Information
Wirral Medicines Management Team
Version 1.0
July 2013
NHS Gloucestershire recommends reducing the dose by 50-75mg per week
http://www.gloshospitals.nhs.uk/SharePoint19/Chronic%20and%20Acute%20Pain%20
Services%20Web%20Documents/Pregabalin%20review%20(neuropathic%20pain)%2
0mg%204%20(2).pdf
Suggested withdrawal schedule for a dose of 150mg bd (based on table from above
reference):
Week 1
Week 2
Week 3
Week 4
Stop and
review
Morning
150mg
75mg
150mg
25mg
patient
Evening
75mg
75mg
50mg
25mg
Gabapentin Titration Schedule
Gabapentin can be given with or without food and should be swallowed whole with
sufficient fluid-intake (e.g. a glass of water).
Standard schedule
Day 1
Morning
Midday
Night
300mg
Day 6
Morning
300mg
Midday
300mg
Night
600mg
Accelerated schedule
Day 1
Morning
300mg
Midday
300mg
Night
600mg
Day 6
Morning
300mg
Midday
600mg
Night
600mg
Day 2
300mg
300mg
Day 7
300mg
600mg
600mg
Day 2
300mg
300mg
300mg
Day 7
600mg
600mg
600mg
Day 3
300mg
300mg
300mg
Day 8
300mg
600mg
600mg
Day 3
300mg
300mg
600mg
Day 8
600mg
600mg
600mg
Day 4
300mg
300mg
300mg
Day 9
600mg
600mg
600mg
Day 4
300mg
300mg
600mg
Day 9
600mg
600mg
900mg
Day 5
300mg
300mg
600mg
Day 10
600mg
600mg
600mg
Day 5
300mg
600mg
600mg
Day 10
600mg
600mg
900mg
Based on individual patient response and tolerability, the dose can be further increased
in 300 mg/day increments every 2-3 days up to a maximum dose of 3600 mg/day.
Slower titration of gabapentin dosage may be appropriate for individual patients. The
minimum time to reach a dose of 1800 mg/day is one week, to reach 2400 mg/day is a
total of 2 weeks, and to reach 3600 mg/day is a total of 3 weeks1.
Elderly patients (over 65 years) and patients with compromised renal function may
require dosage adjustment because of declining renal function.
Prescribing incentive scheme: Pregabalin Information
Wirral Medicines Management Team
Version 1.0
July 2013
Somnolence, peripheral oedema and asthenia may be more frequent in elderly
patients.
Price comparison Table (April 2013 Drug Tariff)
Drug and dose
Gabapentin 100mg tds
Gabapentin 300mg tds
Gabapentin 400mg tds
Gabapentin 600mg tds
Gabapentin 2x300mg tds
Gabapentin 800mg tds
Gabapentin 2x400mg tds
Pregabalin 25 or 50 or 75 or 100 or 150 or 200 or 225
or 300mg bd
Pregabalin 25 or 50 or 75 or 100 or 150 or 200mg tds
Cost for 28
days
£2.12
£2.90
£3.79
£9.41
£5.80
£33.21
£7.58
£64.40
Cost per
year
£27.56
£37.70
£49.27
£122.33
£75.40
£431.73
£98.54
£837.20
£96.60
£1255.80
References
1. An update on the drug treatment of neuropathic pain Part 1 DTB 2012; 50(10): 114-7
2. An update on the drug treatment of neuropathic pain Part 2 DTB 2012; 50(11): 126-9
3. Moore RA et al. Gabapentin for chronic neuropathic pain and neuralgia in adults. Cochrane database of
systematic reviews 2009, Issue 3
4. Moore RA al. Pregabalin for acute and chronic pain in adults. Cochrane 2011, Issue3
5. Wirral Clinical Guideline for the management of neuropathic pain
http://mm.wirral.nhs.uk/document_uploads/guidelines/NeuropathicPain-clinicalguidelinev2.pdf
6. NHS choices http://www.nhs.uk/medicineguides/pages/MedicineSideEffects.aspx?condition=Neuropathic%20pain&medicine=pregabalin
7. eMC Neurontin SPC Accessed 5.3.13
8. UKMi Q&A 408.1 How do you switch between pregabalin and gabapentin for neuropathic pain, and vice versa?
2012
9. Toth C Substitution of gabapentin therapy with pregabalin therapy in neuropathic pain due to peripheral
neuropathy. Pain Medicine 2010; 11:456-465
10. NICE Clinical Guideline 66 The Management of Type 2 Diabetes
http://www.nice.org.uk/nicemedia/pdf/CG66NICEGuideline.pdf
Prescribing incentive scheme: Pregabalin Information
Wirral Medicines Management Team
Version 1.0
July 2013