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Rational dosing of gabapentin and pregabalin in chronic kidney disease J Pain Res. 2017 Jan 27:10:275-278. doi: 10.2147/JPR.S130942. eCollection 2017. Authors Objective was to compare efficacy and safety of Pregabalin and Gabapentin in uremic pruritus among patients of chronic kidney injury undergoing haemodialysis. It was a comparative cross-sectional study, conducted at the Department of nephrology Abbottabad International Medical Institute. Epidemiology and pathogenesis of analgesic-related chronic kidney disease; Evaluation of chronic pain in adults; Fibromyalgia: Treatment in adults; HIV-associated distal symmetric polyneuropathy (HIV-DSPN) Ketamine and esketamine for treating unipolar depression in adults: Administration, efficacy, and adverse effects; Management of diabetic Gabapentin is not metabolized, and it is solely eliminated by renal excretion; pregabalin is not appreciably metabolized, and it is over 90% renally eliminated. 2,46,47 Accordingly, clinical practice recommendations and published reviews for the management of neuropathic pain in ESRD recommend conservative dosing of gabapentin and pregabalin Pregabalin and gabapentin are often considered first-line treatments for various neuropathic pain syndromes, generally irrespective of cause. 1 Because the products are so variable, this article compares the pharmacokinetics (PK) and pharmacodynamics (PD) of pregabalin with various gabapentin formulations, and also covers conversion regimens. 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. Gabapentin Has saturable absorption. Titrate slowly; doses up to 300 mg per day are generally considered safe in dialysis patients. Pregabalin Has similar efficacy and side effects as gabapentin. May be useful in patients with limited absorption from gabapentin, e.g. not responding despite high doses. Renal dose adjustments for gabapentin and pregabalin are ubiquitously evident in the medical literature. All manufacturers for these branded and generic dosage forms list dosing recommendations relative to creatinine clearance (CrCl) for both medications (Table 1).1,2 However, the basis of these recommendations has not been well articulated. Both Lyrica and gabapentin are used as anti-epileptic medications and to treat nerve pain. But there are several differences between them. The main differences between Lyrica and gabapentin are: Lyrica is a brand name for pregabalin. Gabapentin is a generic name - brands of gabapentin include Neurontin, Gralise, and Horizant. Keywords: Gabapentin, pregabalin, pain management, adverse effects, pharmacology. Introduction. The gabapentinoid drugs gabapentin and pregabalin are antiepileptic drugs that are considered as first-line treatments for the management of neuropathic pain. 1 Pregabalin is also approved for generalised anxiety disorders in the United Kingdom. The Patients were randomly divided into two groups (Group A and B), with Group A receiving pregabalin 25 mg and Group B receiving gabapentin 100 mg. The efficacy and safety of drugs were assessed after 6 weeks using visual analog scale and 5D itch scale. Background: Gabapentin and pregabalin are well-tolerated medications primarily cleared by the kidney. Patients receiving higher gabapentinoid doses with decreased kidney function may be at an increased risk of adverse effects (AEs), but limited evidence exists evaluating gabapentinoid dosing and AEs in this population. Pain is one of the most common and distressing symptoms among patients with chronic kidney disease (CKD) . The prevalence of pain has been associated with substantially lower health-related quality of life and greater psychosocial distress, insomnia, and depressive symptoms [ 2-9 ]. Notwithstanding, most reports of toxicities were associated with concentrations higher than 15 mg/L for gabapentin and concentrations higher than 13 mg/L for pregabalin, whereas individuals with normal renal function on maximum recommended dosing yielded concentrations of ~5–8 mg/L for gabapentin and 2.8–8.2 mg/L for pregabalin. 22–25 The 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. If you have serious renal impairment, talk to your kidney specialist before trying either drug. References for Gabapentin vs Pregabalin. Siler AC, et al. J Pain Gabapentinoids, including gabapentin and pregabalin, are frequently prescribed as opioid alternatives. Given that gabapentinoids are eliminated from the body by the kidney, we sought to determine the risk of serious adverse events in patients with chronic kidney disease who started a gabapentinoid at a higher versus a lower dose. Gabapentin and pregabalin are commonly used for neuropathic pain in CKD patients but are not fully understood as this population remains excluded from efficacy and safety trials. Renal adjustments for the gabapentinoids are prodigiously recommended in the literature. Bockbrader HN, et al. (2013). Gabapentin to pregabalin therapy transition: A pharmacokinetic simulation. Cao X, et al. (2022). A meta-analysis of We have demonstrated that both gabapentin 100 mg and pregabalin 25 mg improve pruritus in dialysis patients compared with baseline (no therapy). There were no significant differences observed between the two drugs.
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