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

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperReviewResearchpeer-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.

Original languageEnglish
JournalPostgraduate Medicine
Pages (from-to)1-9
Number of pages9
Publication statusPublished - Jan 2021

    Research areas

  • Abuse, adverse events, asymmetric dosing, general practice, neuropathic pain, pregabalin, side effects, ‘low and slow’ approach

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