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 / Gabapentin total daily dose post switch (Toth study9) / Suggested daily dose of gabapentin150mg / 900mg / 300mg tds
225mg / 901mg to 1500mg / 400mg tds
300mg / 1501mg to 2100mg / 2x300mg tds
450mg / 2101mg to 2700mg / 2x400mg tds
600mg / 2701mg to 3600mg / 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
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.
NHS Gloucestershire recommends reducing the dose by 50-75mg per week
Suggested withdrawal schedule for a dose of 150mg bd (based on table from above reference):
Week 1 / Week 2 / Week 3 / Week 4 / Stop andreview
patient
Morning / 150mg / 75mg / 150mg / 25mg
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 / Day 2 / Day 3 / Day 4 / Day 5Morning / 300mg / 300mg / 300mg / 300mg
Midday / 300mg / 300mg / 300mg
Night / 300mg / 300mg / 300mg / 300mg / 600mg
Day 6 / Day 7 / Day 8 / Day 9 / Day 10
Morning / 300mg / 300mg / 300mg / 600mg / 600mg
Midday / 300mg / 600mg / 600mg / 600mg / 600mg
Night / 600mg / 600mg / 600mg / 600mg / 600mg
Accelerated schedule
Day 1 / Day 2 / Day 3 / Day 4 / Day 5Morning / 300mg / 300mg / 300mg / 300mg / 300mg
Midday / 300mg / 300mg / 300mg / 300mg / 600mg
Night / 600mg / 300mg / 600mg / 600mg / 600mg
Day 6 / Day 7 / Day 8 / Day 9 / Day 10
Morning / 300mg / 600mg / 600mg / 600mg / 600mg
Midday / 600mg / 600mg / 600mg / 600mg / 600mg
Night / 600mg / 600mg / 600mg / 900mg / 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.
Somnolence, peripheral oedema and asthenia may be more frequent in elderly patients.
Price comparison Table (April 2013 Drug Tariff)
Drug and dose / Cost for 28 days / Cost per yearGabapentin 100mg tds / £2.12 / £27.56
Gabapentin 300mg tds / £2.90 / £37.70
Gabapentin 400mg tds / £3.79 / £49.27
Gabapentin 600mg tds / £9.41 / £122.33
Gabapentin 2x300mg tds / £5.80 / £75.40
Gabapentin 800mg tds / £33.21 / £431.73
Gabapentin 2x400mg tds / £7.58 / £98.54
Pregabalin 25 or 50 or 75 or 100 or 150 or 200 or 225 or 300mg bd / £64.40 / £837.20
Pregabalin 25 or 50 or 75 or 100 or 150 or 200mg tds / £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
6. NHS choices
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
Prescribing incentive scheme: Pregabalin InformationWirral Medicines Management Team
Version1.0
July 2013