Higher Doses of Pregabalin for Neuropathic Pain: Is it Safe?

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Pregabalin was more effective in patients who stayed at the lower doses.
Pregabalin was more effective in patients who stayed at the lower doses.

Patients with neuropathic pain who do not respond to a low dose of pregabalin can benefit from a higher dose, according to a study recently published in Journal of Pain Research.1

Pregabalin effectively treats neuropathic pain, and higher doses were found to be more effective than lower doses. However, neuropathic pain remains undertreated in many patients as clinicians are reluctant to give doses that are high enough to reduce pain.

Researchers at Stobhill Ambulatory Care Hospital in Glasgow, United Kingdom, and colleagues analyzed 6 flexible-dose clinical trials of pregabalin in 761 patients with diabetic peripheral neuropathy, peripheral herpetic neuralgia, posttaumatic pain, or postsurgical pain. The study's outcomes were a 30% and 50% reduction in pain levels from baseline for each new pregabalin dose assessed.

The flexible doses pathways were: 150 mg/day only, 150 mg to 300 mg/day, 150 mg to 300 mg to 450 mg/day, 150 mg to 300 mg to 450 mg to 600 mg/day, 150 mg to 300 mg to 600 mg/day, and 300 mg to 600 mg/day.

The results showed that for each dose pathway there was a notably greater percentage of patients reporting 30% or 50% pain improvement as doses escalated. The researchers noted that pregabalin was more effective in patients who stayed at the lower doses (150 mg/day  or 150 mg to 300 mg/day), indicating that such patients are unlikely to need escalating doses of the drug. However, in the patients who did require higher doses, their pain reduction was greater at each escalation.

 

This study indicates that increasing dosage of pregabalin may help alleviate pain without incurring intolerable side effects.

Reference

  1. Serpell M, Latymer M, Almas M, Ortiz M, Parsons B, Prieto R. Neuropathic pain responds better to increased doses of pregabalin: an in-depth analysis of flexible-dose clinical trials. J Pain Res. 2017;10:1769-1776.
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