Anticonvulsant / Neuropathic Analgesic / Anxiolytic Pregnancy: Women of childbearing potential have to use effective contraception during treatment. Should not be used during pregnancy unless clearly necessary (benefit to the mother clearly outweighing potential risk to the foetus). A Nordic observational study of more than 2700 first-trimester-exposed pregnancies showed a higher prevalence of major congenital malformations than in the unexposed population (5.9% vs 4.1%). Pregabalin is excreted in human milk and the effect on newborns/infants is unknown — decide whether to discontinue breast-feeding or the drug.

Pregabalin

Brand names: Lyrica

Pregabalin is a gabapentinoid used for peripheral and central neuropathic pain, generalised anxiety disorder and as adjunctive treatment for focal epilepsy.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 150 mg per day as the starting dose, given in two or three divided doses; the overall dose range is 150 to 600 mg per day

Route: Oral

Frequency: Two or three divided doses per day (BID or TID)

Max: 600 mg per day

Source: UK SPC (eMC) for Alzain 100 mg Capsules, Hard, §4.2 (https://www.medicines.org.uk/emc/product/1761/smpc). ELDERLY (the focus of this page): 'Elderly patients may require a dose reduction of pregabalin due to a decreased renal function (see patients with renal impairment).’ The SPC gives no separate numeric elderly regimen — the reduction is driven by creatinine clearance, so use the renal table (see renalAdjustment). §4.4 additionally notes that pregabalin-associated dizziness and somnolence 'could increase the occurrence of accidental injury (fall) in the elderly population', and that post-marketing congestive heart failure reports were 'mostly seen in elderly cardiovascular compromised patients'. BEFORE STARTING: a discussion should be held with the patient to put in place a strategy for ending treatment, to minimise the risk of dependence, addiction and drug withdrawal syndrome; treatment should be given for the shortest possible duration (for epilepsy, for as long as the prescriber considers necessary). INDICATION-SPECIFIC TITRATION — Neuropathic pain: start 150 mg/day in two or three divided doses; based on individual response and tolerability may be increased to 300 mg/day after an interval of 3 to 7 days, and if needed to a maximum of 600 mg/day after a further 7-day interval. Epilepsy: start 150 mg/day in two or three divided doses; may be increased to 300 mg/day after 1 week; the maximum dose of 600 mg/day may be achieved after an additional week. Generalised Anxiety Disorder: range 150 to 600 mg/day in two or three divided doses, need for treatment reassessed regularly; start 150 mg/day, increase to 300 mg/day after 1 week, then to 450 mg/day after a further week, and the maximum 600 mg/day after an additional week. DISCONTINUATION: if pregabalin has to be stopped it is recommended this is done gradually over a minimum of 1 week, independent of the indication. HEPATIC IMPAIRMENT: no dose adjustment required. PAEDIATRIC (no per-kg dose is given, hence paedDose is null): safety and efficacy in children below 12 years and in adolescents 12–17 years have not been established and 'no recommendation on a posology can be made'; verify any under-18 use against a children's formulary. METHOD: may be taken with or without food; oral use only. NOTE ON SOURCES: §4.5 (interactions) was not retrieved in this bundle — the interaction entries below are taken from §7 of the US label (Bryant Ranch Prepack pregabalin capsules, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4ac3a79c-4251-45e4-91c4-29396d131e78) and must be checked against the UK §4.5. §4.4 and §4.8 were truncated at the fetch limit.

Dose adjustments

Renal

Pregabalin is eliminated primarily by renal excretion and clearance is directly proportional to creatinine clearance; dose reduction must be individualised by CLcr (SPC Table 1). CLcr ≥ 60 mL/min: starting 150 mg/day, maximum 600 mg/day, BID or TID. CLcr ≥ 30 to < 60 mL/min: starting 75 mg/day, maximum 300 mg/day, BID or TID. CLcr ≥ 15 to < 30 mL/min: starting 25–50 mg/day, maximum 150 mg/day, once daily or BID. CLcr < 15 mL/min: starting 25 mg/day, maximum 75 mg/day, once daily. Haemodialysis: pregabalin is removed effectively from plasma (50% of drug in 4 hours); adjust the daily dose to renal function and give a supplementary single dose of 25 mg (up to 100 mg) immediately after every 4-hour haemodialysis session.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

For adult indications, begin dosing at 150 mg/day. For partial-onset seizure dosing in pediatric patients 1 month of age and older, refer to section 2.4. ( 2.2 , 2.3 , 2.4 , 2.5 , 2.6 ) Dosing recommendations: INDICATION Dosing Regimen Maximum Dose DPN Pain ( 2.2 ) 3 divided doses per day 300 mg/day within 1 week PHN ( 2.3 ) 2 or 3 divided doses per day 300 mg/day within 1 week. Maximum dose of 600 mg/day. Adjunctive Therapy for Partial-Onset Seizures in Pediatric and Adult Patients Weighing 30 kg or More ( 2.4 ) 2 or 3 divided doses per day Maximum dose of 600 mg/day. Adjunctive Therapy for Partial-Onset Seizures in Pediatric Patients Weighing Less than 30 kg ( 2.4 ) 1 month to less than 4 …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-09-23. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Very common (≥1/10): dizziness, somnolence, headache
Common: nasopharyngitis; increased appetite; euphoric mood, confusion, irritability, disorientation, insomnia, decreased libido; ataxia, abnormal coordination, tremor, dysarthria, amnesia, memory impairment, disturbance in attention, paraesthesia, hypoaesthesia, sedation, balance disorder, lethargy
Common eye disorders: blurred vision, diplopia
Uncommon: neutropenia, hypersensitivity, anorexia, hypoglycaemia; syncope, stupor, myoclonus, loss of consciousness, cognitive disorder, mental impairment
Rare / not known: angioedema and allergic reaction; disinhibition, suicidal behaviour and suicidal ideation; convulsions, Parkinsonism; drug dependence. §4.4 also flags severe cutaneous adverse reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), renal failure and post-marketing congestive heart failure
Discontinuation rate due to adverse reactions in controlled studies was 12% for pregabalin vs 5% for placebo, most commonly for dizziness and somnolence

Interactions

From the US label §7 (UK §4.5 not retrieved): pregabalin is predominantly excreted unchanged in urine, undergoes negligible metabolism and does not bind plasma proteins, so pharmacokinetic interactions are unlikely
No pharmacokinetic interactions with carbamazepine, valproic acid, lamotrigine, phenytoin, phenobarbital or topiramate
Pharmacodynamic: additive effects on cognitive and gross motor function when co-administered with oxycodone, lorazepam or ethanol (no pharmacokinetic interaction seen)
US label §5.4 warns of respiratory depression when used with concomitant CNS depressants or in underlying respiratory impairment

Clinical monograph

How it works

It binds to the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, reducing the release of excitatory neurotransmitters.

Prescribing in practice

Pregabalin is a controlled drug (Class C, Schedule 3) with potential for dependence and misuse; assess risk before prescribing and taper to stop.
There is a serious risk of respiratory depression when combined with opioids or other CNS depressants (MHRA warning); use the lowest effective dose and counsel patients and carers.
Sedation, dizziness, weight gain and peripheral oedema are common, and the dose should be reduced in renal impairment.

Monitoring

Monitor for sedation, dizziness and signs of respiratory depression, especially when combined with CNS depressants or in renal impairment. Review continued need, response and any signs of dependence or misuse.

Counselling the patient

Do not stop taking it suddenly; your dose should be reduced gradually to avoid withdrawal effects.
It can make you drowsy or dizzy, especially with alcohol or strong painkillers; do not drive until you know how it affects you.
Seek urgent help if your breathing becomes slow or shallow.

Evidence & guidelines

Guideline-recommended for neuropathic pain (NICE CG173); MHRA warning on respiratory depression with concomitant CNS depressants.

Reference: NICE CG173 (Neuropathic Pain); MHRA Drug Safety Update 2017; AGS Beers Criteria 2023; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways