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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 Pregabalin and gabapentin are both used to treat nerve pain, seizures, and anxiety, but pregabalin has faster absorption, higher bioavailability, and requires lower doses for similar effects compared to gabapentin. Pregabalin vs Gabapentin: Overview. Pregabalin and gabapentin are prescription drugs that are used to treat similar conditions. But these two drugs are not the same. Please continue reading to learn about the differences between pregabalin vs gabapentin . Definition and Classification no clear evidence that either gabapentin or pregabalin is more effective than the other for neuropathic pain,1 patients may bene-fi t from switching. In an open-label study, analgesia improved after switching from gabapentin to pregabalin.3 There is no established guidance on converting between gabapentin and pregabalin.4 The manufacturers of both Gabapentin is not the same as pregabalin, even though they both belong to the same class of medicine, called gabapentinoids, and work similarly. Lyrica and Lyrica CR are the only brands of pregabalin. Neurontin is a brand name for gabapentin. Other brands of gabapentin include Gralise and Horizant. 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. 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 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 We would like to show you a description here but the site won’t allow us. Compare Gabapentin vs Pregabalin head-to-head with other drugs for uses, ratings, cost, side effects and interactions. 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. 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. 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. 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. Gabapentin and pregabalin both require dose adjustment in individuals with reduced renal function. Consult the summary of product characteristics (SmPC) for gabapentin and pregabalin for further information before determining an equivalent dose and switching strategy. 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 second method proposed was a cross-titration where 50% of the existing gabapentin dose was co-administered with 50% of the new pregabalin dose for four days, then the full pregabalin dose was initiated and gabapentin was completely discontinued. 15 The transitions were studied at three dosages using a 6:1 conversion (Table 2). The particular NNTs for pregabalin and gabapentin were 7.71 and 7.16, respectively. 10 A more recent meta-analysis in 2022 specifically focused on post-herpetic neuralgia and found greater efficacy with pregabalin in alleviating pain and improving global perception of pain and sleep. 15 Another meta-analysis published in 2021 reported similar While gabapentin (Neurontin) and pregabalin (Lyrica) share many similarities, there are a few things that set them apart. We’ll highlight seven key differences between these medications below. 1. Pregabalin is FDA approved for more uses than gabapentin, but both are often used off-label.
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