Pregabalin for neuropathic pain in primary care settings: recommendations for dosing and titration

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisReviewForskningpeer review

  • Rainer Freynhagen, Benedictus Hospital, Technical University of Munich
  • ,
  • Ralf Baron, University Hospital Schleswig-Holstein
  • ,
  • Yoshiharu Kawaguchi, Toyama University Hospital
  • ,
  • Rayaz A. Malik, Weill Cornell Medicine
  • ,
  • Diane L. Martire, Pfizer
  • ,
  • Bruce Parsons, Viatris Inc
  • ,
  • Roberto D. Rey, Argentine Institute for Neurological Research , Sanatorio Finochietto
  • ,
  • Stephan A. Schug, University of Western Australia
  • ,
  • Troels Staehelin Jensen
  • Thomas R. Tölle, Technical University of Munich
  • ,
  • Takahiro Ushida, Aichi Medical University Hospital
  • ,
  • Ed Whalen, Pfizer

Pregabalin is one of the first-line treatments approved for the management of neuropathic pain (NeP). While many patients benefit from treatment with pregabalin, they are often treated with suboptimal doses, possibly due to unfamiliarity around prescribing the drug and/or side effects that can occur with up-titration. This narrative review discusses key aspects of initiating, titrating, and managing patients prescribed pregabalin therapy, and addresses concerns around driving and the potential for abuse, as well as when to seek specialist opinion. To ensure that patients derive maximum therapeutic benefit from the drug, we suggest a ‘low and slow’ dosing approach to limit common side effects and optimize tolerability alongside patients’ expectations. When requiring titration to higher doses, we recommend initiating ‘asymmetric dosing,’ with the larger dose in the evening. Fully engaging patients in order for them to understand the expected timeline for efficacy and side effects (including their resolution), can also help determine the optimal titration tempo for each individual patient. The ‘low and slow’ approach also recognizes that patients with NeP are heterogeneous in terms of their optimal therapeutic dose of pregabalin. Hence, it is recommended that general practitioners closely monitor patients and up-titrate according to pain relief and side effects to limit suboptimal dosing or premature discontinuation.

TidsskriftPostgraduate Medicine
Sider (fra-til)1-9
Antal sider9
StatusUdgivet - jan. 2021

Bibliografisk note

Funding Information:
Medical writing support was provided by Karen Burrows, MPhil, and Ray Beck, PhD, of Engage Scientific Solutions, and was funded by Pfizer.

Funding Information:
This manuscript was sponsored by Pfizer.

Funding Information:
The advisory board that hosted the discussion which inspired the development of this article was also funded by Pfizer. None of the authors received honoraria to write this article.

Funding Information:
RB has received consultancy and/or speakers fees from Abbott Products Operations, AbbVie, Akcea Therapeutics, Air Liquide Santé International, Allergan, Alnylam, AstraZeneca, Asahi Kasei Pharma Corporation, Astellas, Bayer, Biotest AG, Boehringer Ingelheim Pharma, Bristol Myers Squibb, Biogen IDEC, Celgene, Daiichi Sankyo, Desitin Arzneimittel GmbH, Eisai, Ethos, Galapagos NV, Genentech, Genzyme, Glenmark Pharmaceuticals, Grünenthal, Hexal, Janssen, Kyowa Kirin, Lateral Pharma, Lilly, Medtronic, Merck, Mundipharma, Pfizer, Novartis, Regeneron Pharmaceuticals, Sanofi, Seqirus, Teva Pharmaceuticals, Theranexus DSV CEA, and Vertex Pharmaceuticals. He has received grant or research support from: EU Projects, Europain, DOLORisk, IMI-PainCare, German Federal Ministry of Education and Research, Joint project: early detection of chronic pain, German Research Network on Neuropathic Pain, Pfizer, Genzyme, Grünenthal, Mundipharma Research GmbH & Co. KG., Novartis Pharma, Alnylam Pharmaceuticals Inc., and Zambon GmbH.

Funding Information:
RAM has received consultancy and/or speakers fees from Pfizer, Novo Nordisk, Merck, and Lilly. He has received investigator-initiated study funding from Pfizer and Proctor & Gamble and research funding from the National Institutes of Health, Medical Research Council, Qatar Foundation, and Michael J. Fox Foundation.

Publisher Copyright:
© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Copyright 2021 Elsevier B.V., All rights reserved.

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