Anticonvulsant / Neuropathic Analgesic / Anxiolytic Pregnancy: Avoid in pregnancy — teratogenicity risk; register with UK Epilepsy and Pregnancy Register

Pregabalin

Brand names: Lyrica

Adult dose

Dose: 150-600 mg/day in two to three divided doses

Route: Oral

Frequency: Twice or three times daily

Max: 600 mg/day

Start 25-75 mg twice daily in elderly; titrate over 1-2 weeks. GAD: 150-600 mg/day

Paediatric dose

Dose: Seek specialist opinion N/A/kg

Route: Oral

Frequency: Seek specialist opinion

Max: Seek specialist opinion

Seek specialist opinion

Dose adjustments

Renal

Significant reduction required: eGFR 30-59: max 300 mg/day; eGFR 15-29: max 150 mg/day; eGFR under 15: max 75 mg/day

Hepatic

No adjustment required

Paediatric weight-based calculator

Patient weight (kg)

Seek specialist opinion

Clinical pearls

MHRA 2017: Pregabalin associated with fatal respiratory depression when combined with opioids or CNS depressants — high-risk combination in elderly with chronic pain
UK Schedule 3 Controlled Drug since April 2019 — misuse potential recognised
Twice-daily dosing improves adherence over gabapentin three times daily — useful in elderly with complex regimens
Weight gain and peripheral oedema common — monitor in elderly with heart failure or mobility issues
Licensed for generalised anxiety disorder (GAD) in addition to neuropathic pain and epilepsy — useful where anxiety and neuropathic pain coexist

Contraindications

Hypersensitivity to pregabalin

Side effects

Dizziness (very common)
Somnolence
Ataxia and falls
Weight gain and oedema
Blurred vision
Cognitive impairment
Respiratory depression (with CNS depressants)

Interactions

Opioids / benzodiazepines (additive respiratory depression — MHRA warning)
Alcohol (additive CNS depression)
Thiazolidinediones (additive oedema)

Monitoring

eGFR (dose adjustment)
Weight and oedema
Sedation and falls risk
Respiratory rate if on concurrent opioids

Reference: BNFc; BNF 90; NICE CG173 (Neuropathic Pain); MHRA Drug Safety Update 2017; AGS Beers Criteria 2023. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways