I often see orders for drugs two or three times daily, and while this can be necessary, sometimes it may not be, and at what cost. Lyrica (pregabalin) is flat priced per Medi-span. What does this mean? It means that 1 capsule of 25 mg is the same cost as 1 capsule of 50 mg or 1 capsule of 75 mg etc. I probably see Lyrica used most often for neuropathy type symptoms. It has action similar to Neurontin (gabapentin). Lyrica is priced at over 300$/mo for 90 capsules per Medi-span, I had a patient on this recently. The dosing was 50 mg three times daily for neuropathy and they were doing well with their pain management, but reducing the dose was not deemed appropriate. In this case, we were able to successfully transition the patient from 50 mg three times daily to 75 mg twice daily. There are many factors that can go into whether transitions like this are appropriate, but we should always be mindful of costs when medications could be changed without changing the quality of care. You could make the argument that care was actually improved at lower cost because the patient had improved quality of life with less pill burden (less pills taken per day). Pharmacokinetics certainly matters in this case, and what you’re treating certainly matters as well. This change allowed a savings of over a hundred dollars a month in healthcare costs. If Lyrica was being used for seizures, we’d certainly be a little more cautious and maybe less likely to try a transition like this depending upon the situation.