Anticonvulsant / Neuropathic Pain Pregnancy: Women of childbearing potential must use effective contraception. A Nordic observational study of more than 2,700 first-trimester-exposed pregnancies showed a higher prevalence of major congenital malformations than in unexposed pregnancies (5.9% vs 4.1%). Pregabalin should not be used during pregnancy unless clearly necessary (benefit to the mother clearly outweighing the potential risk to the foetus). Excreted into human milk with unknown effects on the infant — decide whether to discontinue breast-feeding or pregabalin.

Pregabalin

Brand names: Lyrica

Pregabalin is a gabapentinoid used for neuropathic pain, generalised anxiety disorder, and as an adjunct in 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 initially; dose range 150-600 mg per day

Route: Oral (with or without food)

Frequency: In two or three divided doses

Max: 600 mg per day

Before starting, agree a strategy for ending treatment with the patient to minimise the risk of dependence, addiction and drug withdrawal syndrome; treat for the shortest possible duration. NEUROPATHIC PAIN: start 150 mg/day in two or three divided doses; based on response and tolerability increase to 300 mg/day after an interval of 3-7 days and, if needed, to a maximum of 600 mg/day after a further 7 days. EPILEPSY: start 150 mg/day in two or three divided doses; increase to 300 mg/day after 1 week; maximum 600 mg/day may be achieved after an additional week. GENERALISED ANXIETY DISORDER: range 150-600 mg/day in two or three divided doses, reassessing the need for treatment regularly; start 150 mg/day, increase to 300 mg/day after 1 week, to 450 mg/day after a further week, and to a maximum 600 mg/day after an additional week. DISCONTINUATION: taper gradually over a minimum of 1 week regardless of indication. Elderly patients may require a dose reduction because of decreased renal function. No dose adjustment is required in hepatic impairment. PAEDIATRIC: the UK SPC states safety and efficacy in children below 12 years and in adolescents 12-17 years have not been established and no posology recommendation can be made. (The US label separately carries weight-based paediatric dosing for adjunctive therapy of partial-onset seizures from 1 month of age — not authorised in the UK SPC; verify any paediatric use against a children's formulary.)

Dose adjustments

Renal

Dose reduction must be individualised to creatinine clearance (CLcr): CLcr 60 mL/min or more — starting 150 mg/day, maximum 600 mg/day (BID or TID); CLcr 30 to under 60 mL/min — starting 75 mg/day, maximum 300 mg/day (BID or TID); CLcr 15 to under 30 mL/min — starting 25-50 mg/day, maximum 150 mg/day (once daily or BID); CLcr under 15 mL/min — starting 25 mg/day, maximum 75 mg/day (once daily). Haemodialysis removes about 50% of drug in 4 hours: in addition to the adjusted daily dose, give a supplementary single dose (starting 25 mg, maximum 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 pregabalin or to any of the excipients

Side effects

Dizziness, somnolence and headache (very common)
Ataxia, abnormal coordination, tremor, dysarthria, amnesia, memory impairment, disturbance in attention, sedation, balance disorder, lethargy (common)
Vision blurred, diplopia (common)
Euphoric mood, confusion, irritability, disorientation, insomnia, decreased libido (common)
Increased appetite (common); peripheral oedema and weight gain
Drug dependence and drug withdrawal syndrome on abrupt cessation or dose reduction (frequency not known)

Interactions

Pregabalin is excreted largely unchanged in urine, undergoes negligible metabolism and does not bind plasma proteins — significant pharmacokinetic interactions are unlikely, including with carbamazepine, valproic acid, lamotrigine, phenytoin, phenobarbital and topiramate (US label §7)
Oxycodone, lorazepam and ethanol — no pharmacokinetic interaction, but additive effects on cognitive and gross motor function were seen (US label §7)
Concomitant CNS depressants — respiratory depression may occur, particularly with underlying respiratory impairment; monitor and adjust dosage (US label §5.4)

Clinical monograph

How it works

It binds the alpha-2-delta subunit of voltage-gated calcium channels, reducing release of excitatory neurotransmitters.

Prescribing in practice

It is a controlled drug with recognised misuse potential; taper when stopping rather than stopping abruptly.
Sedation and dizziness are common; reduce the dose in renal impairment, as it is renally cleared.
There is additive respiratory depression with opioids and other sedatives.

Monitoring

No routine blood monitoring; review benefit, sedation, mood and any signs of misuse, and renal function where relevant.

Counselling the patient

Drowsiness and dizziness are common at first and usually settle; take care driving until you know how it affects you.
Do not stop suddenly.
Report low mood or thoughts of self-harm.

Evidence & guidelines

A first-line option for neuropathic pain (NICE CG173) and an option in generalised anxiety disorder.

Reference: NICE NG193; MHRA Controlled Drug Classification 2019; 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

Drugs

Gabapentin · Anticonvulsant / Neuropathic Pain

Pathways