Pregabalin

Pregabalin is a gabapentinoid used for selected anxiety, neuropathic pain and seizure indications. A veterinary oral solution is authorized for acute transport- and veterinary-visit-associated anxiety in cats. Other veterinary applications are extra-label and include adjunctive treatment of refractory epilepsy or neuropathic pain, particularly in dogs.

Group

Anticonvulsant and neuropathic analgesic

Mechanism of Action

Pregabalin binds the alpha2delta auxiliary subunit of voltage-gated calcium channels in neurons. This modifies channel function and trafficking and reduces calcium-dependent release of excitatory neurotransmitters. Reduced excitatory signaling contributes to anxiolytic, analgesic and anticonvulsant effects. Despite its structural relationship to GABA, it does not act as a direct GABA-receptor agonist.

Dose Rates

Dogs

Use / stage	Dose	Route	Schedule	Instructions
Adjunct seizure treatment — Initial	2 mg/kg	PO	Every 8 h	Increase gradually to a tolerated 3-4 mg/kg.
Adjunct seizure treatment — Maintenance	3–4 mg/kg	PO	Every 8 h
Neuropathic pain	4–5 mg/kg	PO	Every 12 h	Starting range; adjust gradually if necessary.
Neuropathic pain or seizure pharmacokinetic regimen	4 mg/kg	PO	Every 12 h	Single-dose exposure study prediction, not demonstrated clinical efficacy.
Adjunct seizure treatment — Maintenance	3–4 mg/kg	PO	Every 8–12 h	Start 2 mg/kg and increase by 1 mg/kg each week as tolerated.

Cats

Use / stage	Dose	Route	Schedule	Instructions
Seizures or neuropathic pain — Initial	2 mg/kg	PO	Every 12 h
Seizures or neuropathic pain — Maintenance	4 mg/kg	PO	Every 12 h
Seizures or neuropathic pain — Initial	1–2 mg/kg	PO	Every 12 h	Anecdotal and single-dose feline studies; titrate cautiously.

Horses

Use / stage	Dose	Route	Schedule	Instructions
Reported pregabalin therapy	4 mg/kg	PO	Every 8 h

Indications

Alleviation of acute anxiety and fear associated with transportation and veterinary visits in cats using the corresponding veterinary oral solution.
Adjunctive treatment of selected neuropathic pain in dogs and cats, including some syringomyelia-associated canine pain, with condition-specific evidence.
Adjunctive treatment of refractory seizure disorders in selected dogs, with a limited veterinary evidence base.

Contraindications

Renal elimination may require individualized treatment; reproductive safety is not established.

Interactions

Other CNS depressants increase sedation.

Adverse effects

Sedation and ataxia, increasing with dose.

Toxicity

Animal overdose experience is limited and no specific antidote is established. Monitor CNS depression and provide supportive care; renal elimination affects duration.

Preparations

Preparation	Form	Strength	Route
Pregabalin capsule 25 mg	Capsule	25 mg / capsule	PO
Pregabalin capsule 50 mg	Capsule	50 mg / capsule	PO
Pregabalin capsule 75 mg	Capsule	75 mg / capsule	PO
Pregabalin capsule 100 mg	Capsule	100 mg / capsule	PO
Pregabalin capsule 150 mg	Capsule	150 mg / capsule	PO
Pregabalin capsule 200 mg	Capsule	200 mg / capsule	PO
Pregabalin capsule 225 mg	Capsule	225 mg / capsule	PO
Pregabalin capsule 300 mg	Capsule	300 mg / capsule	PO
Pregabalin commercial oral solution 20 mg/mL Cited commercial solution: use within 45 days after first opening; not a compounded-liquid beyond-use date.	Oral Liquid	20 mg / mL	PO

Monitoring and Administration

Give with or without food; titrate gradually. Avoid abrupt withdrawal after prolonged use. Monitor sedation, gait and seizure response; compounded stability is unestablished.

The cited commercial pregabalin oral solution has a 45-day in-use period after opening; this does not establish a beyond-use date for compounded liquids.