Conversion of Gabapentin to Pregabalin

In a previous post, I discussed the rare situation of patients being on both gabapentin and pregabalin and some possible explanations for this scenario.  That prompted someone to ask me how to do a conversion of gabapentin to pregabalin.

Let’s set up the scenario; your patient is on pregabalin 150 mg BID and Gabapentin 300 mg three times per day for neuropathic pain.  The first question I would ask the patient and/or provider is “How well is the pain managed?”

The question of where their pain is at would help me decide the route of attack in getting them off of one and onto the other.  If the patient’s pain is well managed, I would simply recommend tapering down on one of these agents.  My preference would be the pregabalin because I know how expensive it is (at least at this time).  The patient may have a strong opinion about which one they feel is working better and that has to be a consideration before developing the taper down plan.

If the patient’s pain is not under control, I would likely go up on one of them at the same time I reduce the other.  Unfortunately there is no perfect dose equivalent of gabapentin to pregabalin.  Some have suggested 300mg of gabapentin to 50 mg of pregabalin, but I also want to remind you of the dose dependent kinetics of gabapentin. 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 daily dose).

There are definitely a lot of different variables that go into this conversion, but the nice thing with this conversion is that we can likely be pretty conservative (i.e. we don’t need to do it all at once.

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6 Comments

  1. Emad Sharafeldin

    we have some cases whom under gabapentin 300 TID not under-control, the physician started pregabalin 150 bid immediately without careful initiation of the dose or even tapering gabapentin dose. what pharmacist response to this order?

    Reply
  2. Bill Jones

    I’d want to know which was started first. How do oyu get both unless one “did not work”. Too many patients get low gabapentin doses and it does not work (no shock) and there is a failure to try a higher dose. If pregabalin was started first, why continue a drug that did not work? Why give more or less the same drug in gabapentin? What evidence is pre and gaba combined is better than one of them?

    Reply
    • Jacquelyn Landrum

      I I have been on gabapentin, 300 mg BID and was switched to 50 mg of the Lyrica BID. Works okay but my brother and husband were given 150 mg BID. The higher dose works better for me

      Reply
  3. Codeine UK Online

    Thanks for sharing this information it’s very helpful to me. We also provide painkiller Codeine Medicine in the UK and our medicines are safe to every normal human body.

    Reply
  4. Jeanette pomfret

    On 800mg gabapentin 3 times a day fine on this changed to pregabalin 2x300mg 2 times daily. Made me sleep 20 hours out of 24 difficult too wake very dangerous for me 36hours too de tox off the pregabalin why? Was it an allergy too inner ingregiant anyone else had same?

    Reply

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Written By Eric Christianson

July 30, 2017

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