Prescribing PREGABALIN for neuropathic pain in adults. Note - as discussed elsewhere on this site Gloucestershire NHS has placed gabapentin as first-line with pregabalin second. This is in keeping with many other localities, feeling that NICE CG96 gives an unbalanced position and given the very large cost savings that can thus be made.
PREGABALIN should be prescribed to titrate as follows, with twice daily dosing:
WEEK 1 (DAYS 1-7) PREGABALIN 75mg TWICE A DAY (b.d.)
WEEK 2 (DAYS 8-14) PREGABALIN 150mg TWICE A DAY
WEEK 3 (DAYS 15-21) PREGABALIN 300mg TWICE A DAY
The initial doses should be administered on a b.d. basis, morning and evening. The drug is not affected by food. There is nothing to be gained by tds dosing.
If the patient is experiencing good pain relief at a lower dose then there is no need to increase up to the higher doses.
The most common side effects experienced include drowsiness and dizziness.
If for any reason the drug is affecting the patient adversely and you wish to reduce the dose it should be done by reducing the daily dose by one (25mg) capsule and trying to maintain this reduced dose for up to a week although you may find you need to reduce the dose still further. (Though adverse effects are usually mild to moderate).
Once 600mg/day has been reached if there is no pain relief then increasing the dose further is unlikely to help and treatment should be discontinued gradually over a minimum of one week.
Some patients may end up taking pregabalin (and other drugs) for a long time and may be getting limited benefit, and the pain for which they are taking it may not be neuropathic. We have formulated guidelines for review and potential dose reduction here.
PREGABALIN is excreted unchanged in the urine. Patients with renal impairment will require dose modification – see drug information or ask for specialist advice.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 19/02/2016