Hi Seahorse,

I agree with this for the same reason and another - that we should always take the least amount of anything required to acheive the desired results. Dosages are usually determined/recommended by the pharmaceutical companies based on averages derived from their studies/trials. Doctors tend to follow these guidelines unless they have experience/reason not to. But this also means "one-size-fits-all" medicine, and since we're all different, those guidelines are going to be too much for some and too little for others (which is my main argument for titrating from lower to higher).

The deal with gabapentin & Lyrica, as I understand it, is this: Gabapentin is an older medication now out of patent (generic). It is often used as a firstline treatment for PN and other neuropathic pain because it sometimes works (despite side effects), and because it is generic, it's cheap.

Lyrica is similar to gabapentin in several ways (some say an improvement on or improved form of - I'm not a chemist/pharmacologist), and ostensibly has (generally) less/fewer side effects, but it is still under patent, therefore more expensive. Some insurance companies/policies will approve Lyrica right off, some will approve it only after gabapentin is tried (and sufficient reason shown for prescribing Lyrica instead) and some will just flat out refuse it.

I have no bias/preference between the two - whatever works - but if cost is an issue, I think I'd give gabapentin a try.

I'm not sure (now) when Lyrica's patent is due to expire; one site says late next year ('13)
http://epilepsy.emedtv.com/lyrica/generic-lyrica.html
while another says '17 - '18
http://www.uspto.gov/patents/resources/terms/156.jsp
(2 patents near bottom of page)

I found this on the FDA's classification of Lyrica as a controlled substance.
http://www.mmm-online.com/setback-fo...article/22504/
This is the first I've heard of this, so I think it's worth pursuing further (factchecking on both patents and this controlled substance issue).

Google: lyrica patent expiration
Google: lyrica controlled substance

Doc