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Actual and modelled bioavailability data6,7 were used to calculate the approximate amount of gabapentin absorbed, then Bock-brader’s potency ratio5 and a correction factor for pregabalin’s bioavailability (90%)1 were applied to develop a conversion algorithm: Conversion of Gabapentin to Pregabalin: Simple & easy Dose equivalencies of Gabapentin & Pregabalin for the conversion protocol Source: apsoc.org.au Clinical Resource: Newsletter Register to Access Content: No An article from the musculoskeletal medicine section of Primary Care Notebook: Switching between gabapentin and pregabalin for neuropathic pain. 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. A tool designed to estimate equivalent dosages between two medications used to treat neuropathic pain and other conditions, pregabalin (brand name Lyrica) and gabapentin (brand names include Neurontin and Gralise), helps healthcare professionals make informed decisions when switching patients between these drugs. For example, if a patient is currently taking 900 mg of gabapentin daily, the An overview of possible dose equivalences, switching methods and considerations to make before switching between gabapentinoids in adults with neuropathic pain. An article from the musculoskeletal medicine section of GPnotebook: Switching between gabapentin and pregabalin for neuropathic pain. 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 The gabapentin dosage calculator provides access to different gabapentin dosage regimens and computes its correct dose. An article from the musculoskeletal medicine section of GPnotebook: Switching between gabapentin and pregabalin for neuropathic pain. 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 begin gabapentin the following day. Patients with a seizure history should be cross-tapered over 1 – 4 From the Guidelines 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 gabapentin daily 1. Gabapentin 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 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. 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 There is no established guidance on the conversion of gabapentin to pregabalin or vice versa. Thus, firm recommendations cannot be made. The product information for pregabalin and gabapentin suggest that both agents should be discontinued over the course of a week, although whether this is relevant for patients with neuropathic pain remains When changing from gabapentin to pregabalin, or the other way around, we need to know the milligram equivalent between these two medications and the reconmended period over which the change should be made. This document provides guidance on converting patients from pregabalin to gabapentin, including recommended total daily doses of gabapentin based on pregabalin dose. It also includes information on titrating the gabapentin dose, adjusting the dose based on renal function, standard and rapid titration schedules for gabapentin, maximum doses, and discontinuing gabapentin gradually over a week. Finally, a trial by Toth C. utilized a conversion algorithm that roughly equates to a gabapentin-to-pregabalin ratio of 6:1. 3 Response Because BT was taking 1800 mg of Neurontin® daily at the time, I recommended that Lyrica® be started at 150 mg BID.
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