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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. 1. 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 2. Cross-taper: A pharmacokinetic simu-lation model compared a stop/start approach with a four-day cross-taper whereby 50% of the gabapentin dose • 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. 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) 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. 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 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) On the contrary, gabapentin is usually dosed three times daily and multiple capsules or tablets may be needed to achieve a specific dose. While both drugs are titrated to effect based on patient response and tolerability, pregabalin may allow for a quicker titration. 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. 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 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. 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 Learn how to taper gabapentin and pregabalin for neuropathic pain and the factors that affect the conversion. No perfect dose equivalent exists, but some suggestions are given based on the scenario and the patient's pain status. 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. 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). ted 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. The second design featured a gradual transition involving coadministration of 50% of the gabapentin dosage and 50% of the desired pregabalin dosage for 4 days, followed by agents. The maximum dose of gabapentin licensed to treat neuropathic pain is 3600mg per day in divided doses. 1,5 The maximum dose of pregabalin used to treat neuropathic pain is 600mg per day in divided doses. 2,6 Based on these maximum doses, Bockbrader NH et al conducted pharmacokinetic research comparing pregabalin and gabapentin in 2010, and
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