ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Gabapentinoid (Alpha-2-Delta Calcium Channel Ligand) Pregnancy: Avoid — teratogenic in animal studies; human data suggests increased risk of major congenital malformations

Pregabalin

Brand names: Lyrica

Adult dose

Dose: Neuropathic pain/GAD: 75 mg BD, increase to 150 mg BD after 3–7 days; max 600 mg/day. Epilepsy: 150–600 mg/day in 2–3 divided doses.
Route: Oral
Frequency: BD or TDS
Max: 600 mg/day
Class C controlled drug (UK, 2019). More predictable bioavailability than gabapentin. Also licensed for generalised anxiety disorder (GAD).

Paediatric dose

Route: Oral
Frequency: BD–TDS
Max: Not licensed for neuropathic pain or GAD in children
Adjunctive epilepsy: not licensed in children in UK. Off-label use under specialist supervision only.

Dose adjustments

Renal

Significant reduction: eGFR 30–60: 75–300 mg/day; eGFR 15–30: 25–150 mg/day; eGFR <15: 25–75 mg/day (OD)

Hepatic

No dose adjustment required

Clinical pearls

  • Faster onset than gabapentin and more predictable — preferred by some for neuropathic pain
  • Class C controlled drug since 2019 — significant misuse potential
  • MHRA 2019: high-risk combination with opioids — if used together, start at lowest dose, monitor closely
  • For GAD: start 75 mg BD — effective at this dose in clinical trials; review at 4–8 weeks

Contraindications

  • Acute pancreatitis (rare association)

Side effects

  • Dizziness and somnolence (most common)
  • Ataxia
  • Weight gain
  • Peripheral oedema
  • Blurred vision
  • Cognitive impairment
  • Dependence and abuse potential
  • Respiratory depression with opioids

Interactions

  • Opioids — respiratory depression risk (MHRA warning)
  • Lorazepam — additive CNS depression
  • Thiazolidinediones — increased peripheral oedema risk
  • Alcohol — additive CNS depression

Monitoring

  • Renal function (dose adjustment)
  • Signs of respiratory depression
  • Weight and oedema
  • Mental state and dependence indicators

Reference: BNFc; BNF; MHRA Drug Safety Update 2019; NICE NG193; Lyrica SPC. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways