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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 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. 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. Discontinuation symptoms reported include insomnia, nausea, anxiety, pain, and sweating.4 Determining dose equivalence between gabapentin and pregabalin is complicated by gabapentin’s nonlinear bioavailability, in contrast to pregabalin’s linear bioavailability.6 Gabapentin’s bioavailability ranges from 80% with 100mg tds6 to 35% with 1 Learn how to switch between gabapentin and pregabalin in adults with neuropathic pain, with dose equivalences, switching methods and considerations. See examples of how to calculate and adjust doses using a 6:1 ratio and different strategies. 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 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 Opioid dose conversion chart, syringe driver doses, rescue/PRN doses and opioid patches. Use the conversion chart to work out the equivalent doses of different opioid drugs by different routes. Source: yorkhospitals.nhs.uk; Clinical Resource: Chart; Register to Access Content: No A chart showing the conversion between Lyrica and gabapentin doses for neuropathic pain. The web page also provides information on Shingrix, Admelog, and testosterone formulations. 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 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 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. 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. The product information suggests gradual discontinuation over a week, but this may not be necessary for neuropathic pain. See a table of dose substitution based on limited studies. Learn how gabapentin and pregabalin differ in pharmacokinetics, pharmacodynamics, and indications for neuropathic pain. Find out how to convert gabapentin to pregabalin and what dosing regimens to use. 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. 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. 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) 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%
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