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Patients with Renal Impairment: Pregabalin is eliminated from the systemic circulation primarily by renal excretion as unchanged drug. Since pregabalin clearance is directly proportional to creatinine clearance, dosage reduction in patients with compromised renal function should be individualized according to the creatinine clearance (CrCl) to be determined using the Cockroft-Gault formula. Patients previously on gabapentin should have a wash-out period of one week prior to start dosing with pregabalin.
Pregabalin is effectively removed from plasma by hemodialysis (50% of drug in four hours). For patients receiving hemodialysis, the pregabalin daily dose should be adjusted based on renal function. In addition to the daily dose, a supplementary dose should be given immediately following every four-hour hemodialysis treatment (Table). (See table.)
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