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Lyrica Gabapentin: An Easy Switch! 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 . If considering switching a patient from Gabapentin to Pregabalin, or vice-versa, the following equivalence is suggested with Pregabalin roughly six times more potent than Gabapentin: One drug should be discontinued after a final evening dose, with the new drug commenced the following morning. This document provides guidance on converting patients from pregabalin to gabapentin, including recommended total daily doses of gabapentin based on pregabalin dose. 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). The first proposed conversion method was similar to the method used in the Toth study, where gabapentin was immediately discontinued and pregabalin was initiated at the next scheduled dose. 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. Direct conversion is the most widely used strategy for conversion between gabapentinoids and has been proven safe Transition from gabapentin to pregabalin was seamless and rapid, with predicted pregabalin-equivalent concentrations highly comparable with plasma pregabalin concentrations within 1 day of pregabalin initiation in the immediate discontinuation model and within 1 day of gabapentin cessation in the gradual discontinuation model. There are a lot of factors that can go into the conversion of gabapentin to pregabalin. I lay out a few ideas on this sometimes challenging conversion. 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 Converting 150 mg of Lyrica to gabapentin requires careful consideration, as the equivalent dose typically ranges between 600 mg and 900 mg. However, individual factors like the condition being treated, patient response, and tolerability can influence the conversion process. An in-house pharmacokinetic simulation suggests that a regime of halving the original gabapentin dose, and introducing half the intended dose of pregabalin on day 0, then stopping gabapentin and doubling the pregabalin dose on day 4 leads to fairly stable drug levels of pregabalin equivalents. Guideline for switching pregabalin to gabapentin, including dosage, renal adjustments, titration, and cost. A population PK study by Bockbrader, et. al., used a ratio of 6:1 when evaluating the conversion from gabapentin to pregabalin. 1 Another study calculated that the analgesic effects of pregabalin are about six times greater than those of gabapentin. 2 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. Switching from gabapentin to pregabalin Pauline McQuoid Gabapentin and pregabalin are fully subsidised on prescription in New Zealand. Originally developed as anti-convulsants, they are more widely used for neuropathic pain. Worked example A 42-year-old woman takes 200mg of pregabalin twice a day for neuropathic pain. Due to lack of efficacy, you wish to switch to gabapentin. Use the step-wise approach, to calculate an appropriate dose of gabapentin: 200mg x 2 times a day = 400mg pregabalin daily 400mg x 6 = 2400mg gabapentin daily To convert Lyrica (pregabalin) 50 mg BID to gabapentin, I recommend starting with gabapentin 300 mg three times daily (900 mg total daily dose). This conversion is based on the general principle that pregabalin is approximately 6 times more potent than gabapentin, making 100 mg of pregabalin (50 mg BID) roughly equivalent to 600-900 mg of 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. Guidance for healthcare professionals on switching between pregabalin and gabapentin for neuropathic pain. Includes dosing and tolerability.
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