Treatment of Polyneuropathy in the Elderly

Comparison between Pregabalin and Gabapentin

The American College of Cardiology recommends pregabalin as a first-line treatment for polyneuropathy in the elderly due to its linear pharmacokinetics, simpler dosing regimen, and faster titration compared to gabapentin 1
Pregabalin has a more predictable pharmacokinetic profile, allowing for more predictable dosing, and can provide analgesia more rapidly than gabapentin 1
The dosing regimen of pregabalin is simpler, typically twice a day, while gabapentin requires administration three times a day 1

For elderly patients, it is recommended to start pregabalin with low doses of 25-50 mg/day, with gradual titration based on response and tolerability 1
For gabapentin, the initial recommended dose for elderly patients is 100-200 mg/day, significantly lower than the standard doses for young adults (900-3600 mg/day) 2, 3

Both pregabalin and gabapentin are effective for conditions of neuropathic pain, including polyneuropathy 4, 5
Gabapentin is recommended as a first-line treatment for peripheral neuropathic pain in the elderly 5, 3

Pregabalin is a controlled substance (Schedule V in the US), which should be considered when prescribing for the elderly 1

If gabapentinoids are not effective, consider inhibitors of serotonin and norepinephrine reuptake (SNRIs) such as duloxetine (60 mg/day) 5, 3
Tricyclic antidepressants should be used with caution in the elderly due to anticholinergic effects and cardiac risks 3, 1
Topical treatments such as lidocaine can be considered for focal pain, with excellent tolerability in elderly patients 2, 3