Pregabalin and gabapentin, two alpha-2-delta ligands, have demonstrated efficacy in neuropathic pain associated with diabetic peripheral neuropathy (DPN) and postherpetic neuralgia (PHN). However, pregabalin has nonsaturable absorption at clinically relevant doses, resulting in linear pharmacokinetics and a more predictable exposure compared to gabapentin. Our objective was to compare the attainment of labeled minimally effective dose levels among new users of pregabalin (≥150 mg/day in DPN and PHN) or gabapentin (≥1800 mg/day in PHN). Using the PHARMetrics® database we identified 1,237 patients newly prescribed pregabalin (available in the US since September 05) (age: 54.6±7.8, 53.4% female) and 2,816 patients newly prescribed gabapentin (age: 56.2±7.8, 55.6% female). We evaluated dosage of up to the first three consecutive prescriptions among these patients. Among pregabalin users receiving only 1 prescription, 84.5% received ≥150 mg/day; among those with 2 consecutive prescriptions, 88.6% received ≥150 mg/day by their second prescription; and among those with three consecutive prescriptions, 89.9% received ≥150 mg/day by their third prescription. Approximately one third of patients who received <150 mg/day received a clinically effective dose at their subsequent prescription. Among gabapentin users receiving only 1 prescription, 37.1% received ≥1800 mg/day (47.8% received ≤900 mg/day); among those receiving 2 consecutive prescriptions, 34.2% received ≥1800 mg/day by their second prescription (47.6% received ≤900 mg/day); and among those with 3 consecutive prescriptions, 41.8% received ≥1800 mg/day by their third prescription (39.7% received ≤900 mg/day). Less than 5% of patients who received <1800 mg/day received a clinically effective dose at their subsequent prescription. Our results suggest that compared to gabapentin, a substantial majority of patients prescribed pregabalin received a dose within the clinically effective dose range early in their treatment regimen. Among patients prescribed less than minimally effective doses, a considerably larger proportion of pregabalin patients achieved therapeutic dose levels within our timeframe of observation.