Diabetic Peripheral Neuropathy – Pregabalin to 600mg or bust

I am used to 75-150 mg doses of pregabalin but doses of 300 mg BID are being used for diabetic peripheral neuropathy.

BMC Neurol. 2008 Sep 16;8(1):33.
Efficacy and safety of pregabalin 600 mg/d for treating painful diabetic peripheral neuropathy: a double-blind placebo-controlled trial. Arezzo JC, Rosenstock J, Lamoreaux L, Pauer L

free article here

1) DM peripheral neuropathy occurs in 20% of diabetics and in 50% of cases that have had DM > 25 years.

2) they list symptoms as:

  • tingling
  • pain
  • numbness or weakness in the feet and hands
  • severe dysesthetic burning with nighttime worsening
  • allodynia
  • insomnia
  • anxiety or depression

3) Peripheral edema was 10-17% which is disturbing since diabetic agents that cause edema are associated with increased heart failure. It always bothers me how there is a big push to max doses – and then side effects show up and it’s gone. I hope this does not happen here.

4) They found the BID dosing much more convenient than TID.

5) Response rate? – 49% vs 23% in controls

When is this ever going to get covered?

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One Response to Diabetic Peripheral Neuropathy – Pregabalin to 600mg or bust

  1. admin says:

    Didn’t take long to find my concerns were true:

    J Cardiovasc Med (Hagerstown). 2008 Sep;9(9):922-5.
    Possible heart failure exacerbation associated with pregabalin: case discussion and literature review. Page RL 2nd, Cantu M, Lindenfeld J, Hergott LJ, Lowes BD.

    Re pregabalin (lyrica):
    They have 3 cases of heart failure and refer to 3 other cases. On Lyrica and like it? Maybe you should stock up because the heart failure cases could be the end of that drug… Then again it could end up like Avandia – just cautioned use in cardiac disease.

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