Pregabalin Dosing for Elderly Patients with Peripheral Neuropathy and Renal Impairment

Adjunctive Therapy Options

The American Geriatrics Society recommends starting tricyclic antidepressants (TCAs) at a low dose of 10 mg/day in elderly patients, especially those >75 years, with a maximum dose of 75 mg/day 1, 2, 3
The American Diabetes Association suggests that serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine, can be effective for neuropathic pain with a number needed to treat (NNT) of 5.2 for 60 mg/day, and have the advantage of not being associated with weight gain 2, 4, 5
The National Comprehensive Cancer Network recommends considering topical agents, such as lidocaine 5% patch or capsaicin cream, for localized pain due to their minimal systemic side effects 4, 5, 6, 7

The American Heart Association suggests that when adding adjunctive therapy, especially in patients with cardiovascular disease, it is crucial to assess for comorbidities that may influence the choice of agent, and consider a "low and slow" approach 2, 3
The Journal of the American Geriatrics Society recommends monitoring for sedation, dizziness, and cognitive effects with combined therapy, as well as assessing for anticholinergic effects if using TCAs 2, 3, 6, 8

The National Institute of Neurological Disorders and Stroke suggests evaluating pain reduction after 2-4 weeks of adjunctive therapy, and considering treatment successful if pain is reduced by ≥30% from baseline 4, 9
The American Academy of Neurology recommends that if there is an inadequate response after 4 weeks at maximum tolerated dose, an alternative agent should be considered 4, 5