Pregabalin for neuropathic pain in primary care settings: recommendations for dosing and titration

Abstract

Pregabalin is one of the first-line treatments approved for the management of neuropathic pain (NeP). While many patients benefit from treatment with pregabalin, they are often treated with suboptimal doses, possibly due to unfamiliarity around prescribing the drug and/or side effects that can occur with up-titration. This narrative review discusses key aspects of initiating, titrating, and managing patients prescribed pregabalin therapy, and addresses concerns around driving and the potential for abuse, as well as when to seek specialist opinion. To ensure that patients derive maximum therapeutic benefit from the drug, we suggest a 'low and slow' dosing approach to limit common side effects and optimize tolerability alongside patients' expectations. When requiring titration to higher doses, we recommend initiating 'asymmetric dosing,' with the larger dose in the evening. Fully engaging patients in order for them to understand the expected timeline for efficacy and side effects (including their resolution), can also help determine the optimal titration tempo for each individual patient. The 'low and slow' approach also recognizes that patients with NeP are heterogeneous in terms of their optimal therapeutic dose of pregabalin. Hence, it is recommended that general practitioners closely monitor patients and up-titrate according to pain relief and side effects to limit suboptimal dosing or premature discontinuation.

A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction

“…27 Additionally, MMA has been shown to promote better pain control at outpatient follow-up and reduce hospital readmissions in patients undergoing surgery. 29 Some studies, however, state that for patients who are on gabapentin for a short period of time, tapering could be done in the span of 3-7 days. [30][31][32] At our center, we recommend gabapentin be tapered by 150 mg daily in the span of 5 days postdischarge (if patients were receiving gabapentin three times daily as inpatients) or be tapered in 1 day with a total dose of 150 mg (if patients were receiving gabapentin once daily as inpatients).…”

Diabetische Neuropathie und diabetischer Fuß (Update 2023)

“…In einer Metaanalyse fand sich ein besseres Ansprechen bei einer Tagesdosis von 600 mg im Vergleich zu der Tagesdosis von 300 mg [ 41 ]. Eine langsame Aufdosierung wird empfohlen [ 42 ].…”

A randomized, active-controlled, parallel, open-label, multicenter, phase 4 study to compare the efficacy and safety of pregabalin sustained release tablet and pregabalin immediate release capsule in type II diabetic patients with peripheral neuropathic pain

“…[10] There is evidence that the efficacy of pregabalin against painful DPN is dose-dependent. [1,[11][12][13] It can be administered twice or occasionally 3 times daily, and most patients require 300 mg/d or more for symptomatic relief. Recently, an extended-release formulation of pregabalin was approved by the U.S. Food and Drug Administration for the treatment of painful DPN and postherpetic neuralgia.…”