Lyrica dosage, forms, and strengths

Lyrica (pregabalin) is a prescription drug that is typically prescribed for neuropathic pain and fibromyalgia. It can also be used as an adjunctive treatment for partial onset seizures. The exact mechanism of action of Lyrica is not fully understood, but it has been shown to reduce the release of pain neurotransmitters in the spinal cord, similar to gabapentin. This differs from other analgesics in that it is specifically helpful for nerve pain relief. It is believed that Lyrica works through multiple pathways in the body. Lyrica is usually taken in divided doses two to three times per day with or without food. 

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Lyrica forms and strengths

• Capsule: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg

• Liquid solution: 20 mg per mL

Lyrica dosage for adults

Lyrica dosing will depend on the condition it is treating. For adults, the starting dose is 150 mg per day. The dosage is titrated to a desired dose with a maximum of 600 mg per day. However, fibromyalgia patients usually have a maximum dosage of 450 mg per day.

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The dosages above are for adults. Lyrica is approved for partial onset seizure adjunctive treatment for those who are 1 month to 16 years old. For this age group, dosing is based on weight, which can be seen in the children’s dosage section. 

Lyrica dosage for diabetic peripheral neuropathy

Lyrica can be used to treat neuropathy that is caused by diabetes. Neuropathy is a condition that affects the peripheral nerves of the central nervous system. Symptoms of neuropathy include pain, numbness, weakness, or a pins-and-needles feeling.  

The starting dose is usually 50 mg by mouth three times daily. Within the first week, the dose can be increased to 100 mg by mouth three times daily. Doses higher than 300 mg per day are usually not effective and may increase potential side effects of pregabalin, or Lyrica. However, Lyrica can be taken up to 600 mg per day if needed. When discontinuing Lyrica, taper the dose over one week.

Lyrica dosage for spinal cord neuropathic pain

When treating neuropathic pain associated with spinal cord injury, Lyrica can be started at 75 mg by mouth twice a day. Within the first week, it can be increased to 150 mg by mouth twice a day. After another two to three weeks, it can be increased again to 300 mg by mouth twice a day, which is the maximum dose for this medication. It should also be tapered over one week when discontinuing this medication. 

Lyrica dosage for postherpetic neuralgia

Lyrica can be used to treat postherpetic neuralgia, which is the most common complication of herpes zoster, also known as shingles. It usually presents as a burning pain that can persist for weeks, months, or sometimes years after a shingles outbreak. 

The starting dosage for postherpetic neuralgia is 150 mg by mouth per day, divided into two or three doses. Within the first week, it may be increased to 300 mg by mouth per day, also divided into two or three doses. After another two to four weeks, it may be increased to 600 mg by mouth per day, which is the maximum dose. It should be tapered over one week when discontinuing this medication. 

Lyrica dosage for fibromyalgia

Fibromyalgia is a condition characterized by aches, pains, tenderness, and fatigue. The exact cause of this condition is unknown, but it is believed to be caused by pain signals from the brain. Lyrica can help treat some of the pain caused by fibromyalgia. The starting dose is 75 mg by mouth twice a day. Within the first week, it may be increased to 150 mg by mouth twice a day. The maximum dose of Lyrica for fibromyalgia is usually 450 mg per day, although it can be taken up to 600 mg per day. However, doses higher than 450 mg per day have been shown to be ineffective in treating fibromyalgia with an increased risk of side effects. When discontinuing Lyrica, it should be tapered over one week.

Lyrica dosage for partial onset seizures

Lyrica can also be used to treat partial onset seizures as an adjunctive therapy, which means that it is added to other medication regimens. For this indication, it can be used in patients one month of age and older with weight-based dosing. 

For those that are 17 years of age and older, the starting dose is 150 mg by mouth per day, divided into two or three doses. It can be taken up to 600 mg by mouth per day, which is the maximum dosage for all ages. The efficacy of seizure treatments is dose-related, with more seizure control in higher doses. However, higher doses have been shown to cause more side effects and potential risks. 

Lyrica dosage for children

Lyrica is FDA approved for pediatrics as an adjunctive treatment for partial onset seizures. For children that are 1 month to 16 years of age, dosing is determined by weight. There are two dosing categories for weight-based dosing. These categories are divided between those that weigh less than 66 pounds (30 kg) and those that weigh 66 pounds (30 kg) or greater. 

* For ages 1 month to 3 years old with a weight less than 66 pounds (30 kg), dosing should be divided into three times per day.

Lyrica dosage restrictions

Lyrica has not shown any significant differences in safety or efficacy in different age groups. Therefore, no dose adjustments are needed for geriatric patients. 

Lyrica may cause fetal harm if taken while pregnant. The exact amount of harm is unclear because there are limited clinical studies. In animal studies regarding reproduction, fetal structural abnormalities were observed. Expecting mothers should always talk to their healthcare providers to weigh the risks and benefits of taking Lyrica. It is recommended to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry if taking Lyrica while pregnant. Breastfeeding while taking Lyrica is not recommended because it passes into the breast milk. It is not known if Lyrica can harm babies, but caution should be taken. Ask a healthcare provider before taking Lyrica while breastfeeding. 

Lyrica has reduced dosing for those with reduced renal function. The dosing varies based on the creatinine clearance (CrCl). There are no dosing adjustments needed for those with reduced hepatic function. Fortunately, irregular hepatic enzymes will not affect the elimination of Lyrica.  

Lyrica dosage for pets

Lyrica can be given to dogs and cats to treat neuropathic pain and seizures. However, consult a veterinarian before giving this medication to a pet. He or she can determine if Lyrica is needed for a pet and what dose is appropriate. 

How to take Lyrica

Lyrica is usually taken by mouth in divided doses with or without food. It is usually taken in two to three doses per day. This medication should be taken as directed by a healthcare provider. The dose should be titrated over a few weeks until getting to the desired dose. 

Lyrica dosage FAQs

How long does it take Lyrica to work?

Lyrica takes about 90 minutes to reach its maximum concentration in the body. The rate of Lyrica’s absorption is decreased when it is taken with food. This extends the time it takes to reach the maximum effect to three hours. This does not mean that Lyrica needs to be taken on an empty stomach because food has not shown to reduce the effectiveness of Lyrica. 

How long does Lyrica stay in your system?

The average half-life of Lyrica, which is the amount of time it takes for half of the drug to leave the body, is about six hours in those with normal renal function. Drugs are usually eliminated after four to five half-lives, so it is estimated that Lyrica should be eliminated from the body after about 30 hours. 

What happens if I miss a dose of Lyrica?

If a dose of Lyrica is missed, it should be taken as soon as remembered. However, if it is almost time for the next dose, the missed dose should be skipped and the next dose should be taken. Extra medication should not be taken to make up for a missed dose. If a dose is missed before bedtime, it should be taken the following morning. If the missed dose is not taken the following morning, then the next dose should be taken at the regular dosing time. Two doses should never be taken at the same time. 

How do I stop taking Lyrica?

Taper Lyrica over a minimum of one week and do not abruptly stop taking it. Symptoms including insomnia, nausea, headache, anxiety, excessive sweating, and diarrhea have been observed in patients who quickly stopped taking Lyrica. Also, as with all medications that treat epilepsy, quickly stopping this medication could potentially lead to increased seizure frequency if Lyrica is being used to treat seizure disorders. Lyrica should not be discontinued without consulting a healthcare provider first. 

Although it is usually recommended to not stop Lyrica abruptly, there are certain exceptions. These include adverse events associated with hypersensitivity reactions (skin redness, blisters, hives, rash, difficulty breathing, or wheezing) and angioedema (swelling of the throat, head, or neck). Angioedema may be life-threatening and can lead to respiratory depression. If these symptoms appear, Lyrica should be discontinued immediately. However, it is important to consult a healthcare professional when stopping Lyrica. 

What is the maximum dosage for Lyrica?

The maximum dosage for Lyrica is 600 mg per day, divided into multiple doses. However, doses more than 450 mg per day have proven to be ineffective in fibromyalgia patients.

What interacts with Lyrica?

Lyrica’s absorption rate is reduced when taken with food, but it does not affect the efficacy. If taken with food, it will take about three hours to get to its full effect, whereas it would take 90 minutes without food. Therefore, Lyrica can be taken with or without food. 

Lyrica is predominantly excreted in the urine unchanged. Less than 2% of Lyrica is metabolized before leaving the body. Because of this, Lyrica does not have any significant drug interactions. Specifically, there are no known drug interactions between Lyrica and other anti-epileptic drugs that occur within the body. 

Lyrica has the ability to reduce cognitive and motor function, so taking it with medications that also cause cognitive and motor impairment, such as oxycodone, lorazepam, or ethanol, may cause additive effects. Take caution when combining Lyrica with medications that have similar side effects, especially opioids and CNS depressants. However, when taken together with these medications, no significant adverse effects were observed in clinical trials. Since Lyrica can affect mood, patients who are already on antidepressants should be assessed before starting Lyrica. 

Caution should be taken in patients with heart failure because Lyrica can increase the risk of edema, which is fluid retention or swelling. Thiazolidinediones, a class of drugs that treats diabetes, also increases the risk of edema. Taking Lyrica with a thiazolidinedione may potentially cause too much fluid retention and possibly lead to heart failure. Consult a healthcare professional before taking these medications together. If needed, the doses can be adjusted so that both of these medications are safe for a patient. 

Lyrica is excreted through the kidneys, so it may be affected by other medications that impact the kidneys. Use lower doses in those with impaired kidney function.

What are some Lyrica side effects?

Common side effects

• Dry mouth

• Confusion, trouble concentrating

• Constipation

• Sleepiness or somnolence

Serious side effects

• Swelling of throat, head, or neck (angioedema)

• Severe dizziness or drowsiness

• Uneven heartbeat

• Allergic reaction: Itching or hives, swelling of face or hands, swelling or tingling in mouth or throat, chest tightness, trouble breathing

• Blistering, peeling, red skin rash

• Blue lips, fingernails, or skin, trouble breathing, chest pain

• Unusual bleeding, bruising, or weakness

• Fever, chills, cough, sore throat, body aches

• Muscle pain, tenderness, or weakness, general feeling of illness

• Sudden or unusual change in moods or behavior, including extreme happiness or new or worsening depression

• Risk of suicidal thoughts

• Rapid weight gain, swelling in your hands, ankles, or feet (edema)

• Blurry or double vision

• Decreased blood platelet count

Dizziness and somnolence had the highest incidence compared to a placebo group in randomized controlled trials. If any serious side effects occur, consult a healthcare professional to make a plan to discontinue Lyrica. Lyrica should be discontinued immediately if there is angioedema or hypersensitivity present because they could be life-threatening. 

Resources

• Medication guide

• Lyrica

• Shingles

• Highlights of prescribing information

• North American Antiepileptic Drug (NAAED) Pregnancy Registry

• Managing neuropathic pain in dogs

• Pharmacokinetics of single-dose oral pregabalin administration in normal cats