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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. dose. 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 in-house pharmacokinetic simulation suggests that a regime of halving the original gabapentin dose, and introducing half the intended dose of pregabalin on day 0, then stopping gabapentin and doubling the pregabalin dose on day 4 leads to fairly stable drug levels of pregabalin equivalents. 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). Gabapentin to pregabalin dose equivalence calculation. using the 6:1 ratio an equivalent dose of gapapentinoid can be determined using a step-wise approach (1) 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) Gabapentin to pregabalin dose equivalence calculation. using the 6:1 ratio an equivalent dose of gapapentinoid can be determined using a step-wise approach (1) 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) No conversion is going to be perfect or at least we won’t know the perfect conversion. 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 Due to lack of efficacy, you wish to switch to gabapentin. Use the step-wise approach, to calculate an appropriate dose of gabapentin: 200mg x 2 times a day = 400mg pregabalin daily; 400mg x 6 = 2400mg gabapentin daily; 2400mg /3 doses = 800mg gabapentin to be given three times a day 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 • It is possible that dosing conversion is not linear between gabapentin and pregabalin. • If using the 6:1 ratio of gabapentin to pregabalin dosing, it is important to note that at some dose ranges, this conversion may be too conservative whereas at other doses/situations it may be too aggressive. We are now recommending a lower starting dose of 75mg at night, or 25–50mg in people who may be susceptible to adverse effects, eg, adults over 75 years old.11 This is consistent with recommendations for both gabapentin and pregabalin to consider lower starting doses and/or slower titration in patients who may be more susceptible to adverse effe Conversion of Gabapentin to Pregabalin: Simple & easy! By Olly Zekry and Prof Stephan A. Schug Introduction Both Gabapentin and Pregabalin bind to the α 2 δ sub unit of voltage-dependent calcium channels, hence reducing the release of excitatory neurotransmitters such as glutamate. They both have analgesic, anticonvulsant, 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. Converting 150 mg of Lyrica to gabapentin requires careful consideration, as the equivalent dose typically ranges between 600 mg and 900 mg. However, individual factors like the condition being treated, patient response, and tolerability can influence the conversion process. 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. whereby 50% of the gabapentin dose and 50% of the target pregabalin dose is given for four days, followed by discontinuation of gabapentin and use of target dose of pregabalin.5 Both approaches were pharmacokinetically comparable. 3. Taper down and stop gabapentin then gradually titrate pregabalin up: This is the approach recommended by the The first step in converting from gabapentin to pregabalin is to adjust the dose. The starting dose of pregabalin is typically lower than the dose of gabapentin you were taking. To determine the appropriate starting dose of pregabalin, your healthcare professional will consider factors such as your medical history, the severity of your symptoms The recommended starting dose of pregabalin is 150mg per day in 2-3 divided doses.2,6 Lower doses should be used in older patients with renal impairment. 2 In practice, pregabalin is often started at 25mg or 50mg at night in older patients. Conversion of Gabapentin to Pregabalin: Simple & easy. Dose equivalencies of Gabapentin & Pregabalin for the conversion protocol. Source: apsoc.org.au; Clinical Resource: Newsletter; Register to Access Content: No Both transition designs were studied at 3 dosage levels: gabapentin 900 mg/d to pregabalin 150 mg/d, gabapentin 1800 mg/d to pregabalin 300 mg/d, and gabapentin 3600 mg/d to pregabalin 600 mg/d. Overall drug exposure achieved during the 2 transition designs was the sum of the gabapentin and pregabalin concentrations, expressed as pregabalin
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