Pregabalin- Splitting the dose

[Walrob66]

Hi,

I wondered if anyone has any advice or experience of splitting their Pregabalin dose before bedtime.

I’ve had RLS for a few years, and the only medication I’ve had is Gabapentin before switching to Pregabalin about a year and a half ago as the Gabapentin wasn’t helping.

I’ve recently increased my Pregabalin to 275mg which I take all in one go at 19.50.

However, despite the increase, I’m still waking a number of times during the night.

I understand from my GP that I’m very close to the maximum dose that should be taken in one go,

When I wake I take Ibuprofen which seems to help ( unless it just working as a placebo), but I know I shouldn’t take as much as I do and it’s not good as a long term solution

Is it worth trying to take say 200mg at 19.30 and then the remaining 75mg at 22.30 when I go to bed?

Over thee last few years I’ve had Ferritin tests that seem to show my leaves are within the normal range.

Any advice would be greatly appreciated.

Kind regards.

[SueJohnson]

The maximum for pregabalin is 450 mg so you still have a ways to go. The usual effective dose is 200 to 300 but you can go up to 450 mg. And there is no need to split the dose. That won't make it any more effective. I assume you are taking it 1 to 2 hours before bedtime.

[Joolsg]

You could certainly try splitting the dose to extend its effectiveness.It can take some time to find the right meds and dose and timing to cover nighttime RLS. Trial and error.

You could also try taking the whole dose half an hour/ hour before bed to see if that stops nighttime break through. (If RLS starts earlier in the evening, splitting the dose might work better for you.)

Pregabalin is better absorbed than gabapentin so there's no need to split the dose usually. In your case, it doesn't seem to be lasting long enough to cover nighttime symptoms, so taking later or splitting the dose might help.

If it doesn't help, you are still below the max dose set out in the Mayo algorithm. As SueJohnson says, 450mg is the max dose.

If your serum ferritin is within 'normal' range, that is usually too low for RLS. You should ask for another fasting full iron panel blood test and raise your ferritin above 100, preferably 200, as that can really help the majority of cases. As your tests were 'normal' you could start taking ferrous bisglycinate pills at night now.

[Walrob66 in reply to Joolsg]

Many thanks for your help.

I’ll look to firstly moving the time I take my dose to nearer bedtime, and if still an issue increasing the dose or playing around with splitting it if needed. It’s good to know I have some headroom for the Pregabalin dose despite my GPs comments. I may take the Mayo clinic info along to my next appointment.

With regards to full iron panel.

I did have the following test results in Oct 2022 (if this is what you refer to Jools).

Serum Iron Level =16.5 (normal range 7.0-29.0)

Serum Transferrin level =2.6g/L (normal range 2.1-2.6).

Transferrin saturation index 25% (normal range 15.0-60.0).

I have been taking 200mg Ferrous Sulfate tablets per day since the above tests and a recent Serum Ferritin test showed 395ug/l (normal range 20.0-275.0).

My GP has told me to come off the Serum Ferritin tablets.

So it does seem that everything is okay as far as Iron levels, but any comments would be appreciated.

I must say I don’t know where I would be without all the guidance that I read on this forum from Sue, Jools, Madlegs and many others. Your help and advice is invaluable and so reassuring.

[Elsie77]

Hi, I tried taking my Pregabalin all at one go , the side effects were awful, so I played about varying the times . I was taking 100mg at 9.00pm and 100mg at 10.15pm to 10.30pm that seemed to work, not perfect but I got more sleep. I still found the speech problems upsetting. One night, I forgot to take the last dose at 10.00 ish and I still slept ok, woke up twice but only for a few minutes. So now it’s 75 mg at 9.00 and 100 mg at 10.00 ish pm. The speech problems are decreasing, I generally wake once in the early hours but with paracetamol and a bit of distraction I generally fall asleep again within 30 minutes. I’ve definitely benefitted from splitting the dose.

[Moonwalker1967]

I have been advised to split the dose to 100 mg in the morning and 100 mg Pregabalin in the evening. Bad idea. I get dizzy from the morning dose and had a nasty fall. Please be careful it does cause dizziness and loss of balance, which is ok when you are getting ready to go to bed.

[SueJohnson in reply to Moonwalker1967]

No reason to take it in the morning since I assume your RLS is at night. Your doctor is prescribing it for pain not RLS.

[Wiggler]

Hi,

I take 50mg AM, 50mg lunch & 175mg 30-60mins before bed. Works well to stave off day time & night time symptoms. I also take 5mg of diazepam with the bedtime dose. Generally sleep is significantly better & able to operate well as soon as I wake up. I'm 50 with a hectic work, parent life and my wife has said she's seen a marked improvement since this regime was prescribed from other options.

Good luck in your journey to the right solution!