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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. 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 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 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 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. 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). 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. 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) In both designs, transition from gabapentin to pregabalin was seamless, with predicted pregabalin-equivalent concentrations comparable following immediate discontinuation of gabapentin and the gradual discontinuation of gabapentin. 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 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. 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. 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 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). 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. studies show that direct conversion from Gabapentin to Pregabalin overnight is successful with no intolerable adverse effects noted at one week after conversion (Toth et al., Howard et al.). In both studies conversion from Gabapentin to Pregabalin was achieved by discontinuation of Gabapentin therapy 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 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 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). 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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