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Pharmacokinetics of Pregabalin in Subjects with Various Degrees of Renal Function

From the Clinical Sciences Department, Pfizer Global Research and Development, Ann Arbor, Michigan. Dr. Posvar's current affiliation is the Scott and White Clinic, Temple, Texas.

The objectives of this study were to determine the single-dose pharmacokinetics of pregabalin in subjects with various degrees of renal function, determine the relationship between pregabalin clearance and estimated creatinine clearance (CL_cr), and measure the effect of hemodialysis on plasma levels of pregabalin. Results form the basis of recommended pregabalin dosing regimens in patients with decreased renal function. Thirty-eight subjects were enrolled to ensure a wide range of renal function (CL_cr < 30 mL/min, n = 8; 30-50, n =5; 50-80, n =7; and > 80, n = 6). Also enrolled were 12 subjects with renal impairment requiring hemodialysis. Each subject received 50 mg of pregabalin as two 25-mg capsules in this open-label, parallel-group study. Pregabalin concentrations were measured using previously validated liquid chromatographic methods. Pregabalin pharmacokinetic parameters were evaluated by established noncompartmental methods. Pregabalin was rapidly absorbed in all subjects. Total and renal pregabalin clearance were proportional (56% and 58%, respectively) to CL_cr. As a result, area under the plasma concentration-time profile (AUC) and terminal elimination half-life (t_1/2) values increased with decreasing renal function. Pregabalin dosage adjustment should be considered for patients with CL_cr < 60 mL/min. A 50% reduction in pregabalin daily dose is recommended for patients with CL_cr between 30 and 60 mL/min compared to those with CL_cr > 60 mL/min. Daily doses should be further reduced by approximately 50% for each additional 50% decrease in CL_cr. Pregabalin was highly cleared by hemodialysis. Supplemental pregabalin doses may be required for patients on chronic hemodialysis treatment after each hemodialysis treatment to maintain steady-state plasma pregabalin concentrations within desired ranges.

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