Skilled panel publishes suggestions for pregabalin for neuropathic ache

An international team of experts in chronic pain specialists has published evidence-based recommendations on the dosing and titration of pregabalin for neuropathic pain in primary care, with a focus on optimizing individual dosing protocols to improve adherence. The recommendations were published in Postgraduate Medicine.

Non-compliance with first-line pregabalin, which includes both patient and clinic-related factors, remains a common challenge in successfully using the drug to treat neuropathic pain. The patient’s perceptions, such as the fear that high doses of pain medication could lead to side effects and addiction, can stand in the way of correct dosage and adherence to therapy.

After a prescription is given, doctors can address patient concerns during a follow-up visit. A plain text review of possible patient side effects, as well as a discussion of patient monitoring, can alleviate anxiety by helping patients feel more informed about their treatment plan.

Regarding the initial dose, the Prescribing Information for Pregabalin for Neuropathic Pain recommends starting at 150 mg, divided into 2 or 3 equal doses per day. Doctors can then increase this dose to 300 mg / day, divided into 2 doses after 3 to 7 days. If necessary, doctors can increase the dosage further to a maximum of 600 mg / day in the following week.

The panel of experts suggests that, based on their clinical experience, patients starting pregabalin 150 mg / day may develop early side effects that may increase the risk of discontinuation. To circumvent this problem, the Panel recommends starting pregabalin at a low dose, even 25 mg / day (for older adults or frail patients) or 50 mg / day in the evening, followed by slow titration to a therapeutic dose.

Regular tolerability monitoring is required during this course of treatment. The Panel adds that if the patient appears to tolerate therapy at these doses, the doses can be gradually increased weekly until maximum clinical response is achieved.

While the doses are slowly increased, clinicians should also help patients meet expectations about therapy, as this can also improve overall compliance. Doctors should continue to remind patients of possible side effects. In addition, clinicians should clearly discuss with patients how a slow titration approach can optimize tolerability, help monitor side effects, and help in finding the most appropriate and effective dose.

The panel of experts concluded that “empowering patients with this knowledge while promoting a” low and slow “approach should help them determine the optimal rate of titration for their individual therapeutic needs.”

Disclosure: This clinical study was sponsored by Pfizer. Several authors on the study stated links to the pharmaceutical industry. For a full list of the authors’ information, see the original reference.


Freynhagen R., Baron R., Kawaguchi Y. et al. Pregabalin for Neuropathic Pain in Primary Care: Recommendations for Dosing and Titration. Postgrad Med. 2021; 133 (1): 1-9. doi: 10.1080 / 00325481.2020.1857992

This article originally appeared on Clinical Pain Advisor

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