ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Anticonvulsant / Perioperative Analgesic Adjunct Pregnancy: Avoid in pregnancy — teratogenicity risk

Pregabalin (Perioperative)

Brand names: Lyrica

Adult dose

Dose: 75-150 mg orally 1-2 hours pre-operatively; 75 mg twice daily post-operatively
Route: Oral
Frequency: Single pre-operative dose; twice daily post-operatively
Max: 300 mg/day (perioperative context)
Twice-daily dosing advantage over gabapentin (three times daily). More predictable bioavailability than gabapentin. Used as part of multimodal enhanced recovery protocols

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 150 mg/day; eGFR 15-29: max 75 mg/day; eGFR under 15: 25-75 mg/day

Hepatic

No adjustment required

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • MHRA 2017: Pregabalin with opioids associated with fatal respiratory depression — same warning as gabapentin; UK Schedule 3 CD since 2019
  • More predictable absorption than gabapentin: linear pharmacokinetics at therapeutic doses vs gabapentin's saturable absorption — more consistent perioperative dosing
  • PROSPECT review: pregabalin reduces acute post-operative pain and opioid consumption; however, concern about persistent post-operative dizziness affecting rehabilitation in orthopaedic ERAS protocols
  • Chronic post-surgical pain (CPSP) prevention: pre-emptive gabapentinoid therapy may reduce risk of CPSP — largest benefit seen in thoracic and mastectomy procedures
  • Misuse potential recognised — CD status introduced following reports of recreational use

Contraindications

  • Hypersensitivity to pregabalin

Side effects

  • Sedation and dizziness
  • Respiratory depression (with opioids — MHRA 2017)
  • Weight gain
  • Peripheral oedema
  • Visual disturbances

Interactions

  • Opioids (additive CNS/respiratory depression)
  • CNS depressants (additive)
  • Thiazolidinediones (additive oedema)

Monitoring

  • Sedation score
  • Respiratory rate (if on opioids)
  • Oedema
  • Pain scores

Reference: BNFc; BNF 90; MHRA Drug Safety Update 2017; PROSPECT Guidelines; Doleman et al. (2015) meta-analysis. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways