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That prompted someone to ask me how to do a conversion of gabapentin to pregabalin. Let’s set up the scenario; your patient is on pregabalin 150 mg BID and Gabapentin 300 mg three times per day for neuropathic pain. Pregabalin (Lyrica®) PGB Primidone (Mysoline®) PRM Felbamate (Felbatol®) FBM Gabapentin (Neurontin®) GBP Lacosamide (Vimpat®) LCM LamoTRIgine (Lamictal®) LTG LevETIRAcetam (Keppra®) LEV LORazepam (Ativan®) LZP ClonazePAM (Klonopin®) CZP Clorazepate (Tranxene®) CLZ DiazePAM (Valium®) DZP Eslicarbazapine (Aptiom®) ESL NO How does pregabalin compare to gabapentin in the treatment of neuropathic pain? David F. McAuley, Pharm.D. GlobalRPh Inc. Pregabalin versus gabapentin: Pregabalin, like gabapentin, is an amino acid derivative of gamma-amino butyric acid (GABA analogue).1,2 Pregabalin is the pharmacologically active S-enantiomer of 3-aminomethyl-5-methyl-hexanoic acid, and has a similar pharmacological profile In both studies conversion from Gabapentin to Pregabalin was achieved by discontinuation of Gabapentin therapy after an evening dose with initiation of Pregabalin therapy the following morning. Dose equivalencies of Gabapentin and Pregabalin The following conversion table was based on the assumption that Pregabalin has Conversion between Lyrica and gabapentin is generally well tolerated and direct switching minimizes potential for gaps in pain relief. In the absence of seizure history, the drugs can be directly interchanged; patients can be advised to discontinue Lyrica and begin gabapentin the following day. An open label study substituted gabapentin with pregabalin in patients with neuropathic pain due to peripheral neuropathy. The author describes an overnight switch from gabapentin to pregabalin, based on a conversion table which is described in the paper as “of the author’s creation” (table 1). This document provides guidance on converting patients from pregabalin to gabapentin, including recommended total daily doses of gabapentin based on pregabalin dose. It also includes information on titrating the gabapentin dose, adjusting the dose based on renal function, standard and rapid titration schedules for gabapentin, maximum doses, and discontinuing gabapentin gradually over a week. Lyrica 150 mg is approximately 2–3 times more potent than gabapentin. This means that lower doses of Lyrica achieve the same therapeutic effects as higher doses of gabapentin, which is why the conversion ratio leans towards 600–900 mg gabapentin for every 150 mg of Lyrica. Pharmacist's Letter membership benefits include:. 12 issues every year — what you need to know and do, right now; Quick, practical reference charts and tools; Comprehensive CE library to meet license renewal and state requirements Several studies reviewing conversion of gabapentin to pregabalin predict that a rough ratio for conversion is about 6:1 gabapentin to pregabalin. In addition, a direct switch from gabapentin to pregabalin seems to be well tolerated, making the conversion simple. Two different gabapentin to pregabalin transition designs were simulated based on their respective population pharmacokinetic profiles. The first design involved immediate discontinuation of gabapentin therapy with initiation of pregabalin therapy at the next scheduled dose period. MEDICATION*TITRATION*SCHEDULE*FOR*GABAPENTIN*&*PREGABALIN* Gabapentin 100MG (Amount of pills to take) Morning Noon Night 1st week X X 1 2nd week X 1 1 3rd week 1 1 1 4th week 1 1 2 5th week 1 2 2 6th week 2 2 2 Gabapentin 300MG (Amount of pills to take) Morning Noon Night 1st week X X 1 2nd week X 1 1 3rd week 1 1 1 There is no established guidance on the conversion of gabapentin to pregabalin or vice versa. Thus, firm recommendations cannot be made. The product information for pregabalin and gabapentin suggest that both agents should be discontinued over the course of a week, although whether this is relevant Conversion from gabapentin to pregabalin or vice versa seems like a daunting task. However, there are a few studies examining such conversions. It is important to note that the studies specifically examined the conversion of gabapentin to pregabalin and the bi-directionality of this conversion was not investigated. Systematic reviews have found moderate quality evidence to support the use of gabapentin and pregabalin in people with peripheral diabetic neuropathy and post-herpetic neuralgia. 4 Approximately 40% of people taking pregabalin (600 mg, daily) and 30% of people taking gabapentin (≥ 1,200 mg, daily) for at least eight weeks achieved ≥ 50% Previously, studies have shown 6:1 conversion factor, from gabapentin to pregabalin. (Pain Med. 2011 Jul;12(7):1112-6.) The Literature: Am J Ther. 2013 Jan;20(1):32-6.* Compared unidirectional switch from gabapentin to pregabalin with two rotation strategies: 1. Direct switch o Stop gabapentin, initiate pregabalin at next scheduled dose period Using the 6:1 ratio an equivalent dose of gapapentinoid can be determined using a step-wise approach. Determine total dose (in mg) taken by an individual in a 24-hour period. Divide total daily dose (in mg) of gabapentin by 6 to give total daily dose of pregabalin (in mg). Pregabalin to gabapentin dose equivalence calculation. using the 6:1 ratio an equivalent dose of gapapentinoid can be determined using a step-wise approach; determine total dose (in mg) taken by an individual in a 24-hour period; multiply total daily dose (in mg) of pregabalin by 6 to give total daily dose of gabapentin (in mg) An open label study substituted gabapentin with pregabalin in patients with neuropathic pain due to peripheral neuropathy. The author describes an overnight switch from gabapentin to pregabalin, based on a conversion table which is described in the paper as “of the author’s creation” (table 1). Table 1: Proposed switching doses. Pregabalin is available as capsules of 25mg, 75mg and 150mg in New Zealand. Stop/start: Take the last dose of gabapentin at night and start the target dose of pregabalin the following day. Two papers utilising this approach reported that it was effective and well-tolerated.3,8.
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