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Converting to Pregabalin. 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. gabapentin, like Lyrica, does have abuse potential. This reinforces the importance of ensuring each patient taking gabapentin has an appropriate indication, dose and frequency to maximize benefit and avoid adverse events or misuse. Daily Dose of Gabapentin (mg/day) Daily Dose of Lyrica (mg/day) 0 – 300 50 301 – 450 75 451 – 600 100 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 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). 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 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) The dose conversion used was gabapentin 3600 mg/day to pregabalin 600mg/day, gabapentin 1800 mg/day to pregabalin 300mg/day and gabapentin 900 mg/day to pregabalin 150 mg/day. Adverse effects Adverse effects are common with gabapentinoids resulting in a discontinuation rate of at least 11%, but 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. The study concluded that pregabalin may provide better analgesic outcomes than gabapentin over a 12-week period. Further head-to-head trials are needed to provide further evidence supporting the use of pregabalin over gabapentin in the treatment of neuropathic pain. There are no validated dose conversions between gabapentin and pregabalin due to differences in pharmacokinetics and varying efficacy seen in studies. However, some authors have proposed dose conversions based on these parameters (see Tables 1 and 2). One switching method suggests daily doses of gabapentin between 901 to 1,500 mg/day should be converted to pregabalin 225 mg/day in two divided How does Gabapentin to Pregabalin conversion take place? To convert from Gabapentin to Pregabalin, the typical guideline is to use a 1:1.5 ratio. If a patient is on 300 mg of gabapentin, they would start with 150 mg of pregabalin. 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. The risks associated with gabapentinoid use. In mid-2018, the funding for gabapentinoids in New Zealand widened (see: “Pregabalin dispensing is on the rise”), which has resulted in increased use and growing safety issues. 2 The Medicines Adverse Reactions Committee has expressed concern that gabapentinoids are not being prescribed or taken appropriately. 2 Following a safety review of gabapentin to pregabalin.3 There is no established guidance on converting between gabapentin and pregabalin.4 The manufacturers of both pregabalin and gabapentin advise that if they are to be stopped or changed to another medication, the dose should be tapered gradually over at least one week.4 This gradual withdrawal is to minimise In the scenario above (gabapentin 300 TID and pregabalin 150 mg BID), if the patient’s pain was not under control, as an initial step, I would probably go up on the gabapentin by 600-900 mg (total daily dose) and reduce the pregabalin by 100-150 mg (total daily dose). Pregabalin is licensed for peripheral and central neuropathic pain whereas gabapentin is licensed for peripheral neuropathic pain only. Use of gabapentin for central neuropathic pain is therefore off-label. Gabapentin and pregabalin are similar drugs but differ in several distinct ways. The main differences are their indications—specific uses that the Food and Drug Administration (FDA) has approved them to treat—and their dosages. Gabapentin to pregabalin conversion: 300 mg gabapentin ≈ 50 mg pregabalin. The dose of gabapentin and dose of pregabalin depend on individual patient characteristics and response to treatment. As switching from gabapentin to pregabalin has not Combination therapy If symptoms persist with either amitriptyline or gabapentin alone, combination therapy of amitriptyline and gabapentin should be considered. Pregabalin (Anticonvulsant) Within NHS Tayside pregabalin may be used in patients who have not achieved adequate pain relief from, or did 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.
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