OBJECTIVES: To compare dosing patterns between duloxetine and pregabalin among patients with diabetic peripheral neuropathic pain (DPNP). METHODS: Using a large administrative claims database in the United States, we examined commercially insured individuals aged 18-64 who dispensed duloxetine or pregabalin in 2006. The date of the first duloxetine or pregabalin prescription dispensed was defined as the index date. All patients selected were diagnosed with DPNP and had continuous enrollment over the 12-month pre- index period. Each patient was classified in the duloxetine or pregabalin cohorts based on the index agent, and all duloxetine or pregabalin prescriptions filled over the 12-month follow-up period were examined. We compared the average daily dose of all prescriptions per person, average daily dose in each of the first 10 prescriptions, and percent of daily dose change from previous prescription between duloxetine and pregabalin cohorts. RESULTS: Among 603 duloxetine patients and 1751 pregabalin patients, the average daily doses of all prescriptions were 51.2mg and 179.8mg for duloxetine and pregabalin, respectively. The average daily doses for the 1st and 10th duloxetine scripts were 53.8mg (95% Confidence Interval (CI): 52.4, 55.2) and 64.9mg, while the numbers were 166mg (95% CI: 162, 170) and 264.3mg (95% CI: 244.1, 284.4) for pregabalin. The changes in daily doses from previous prescription were 0.2-4.0% for duloxetine and 0.8-12.5% for pregabalin, respectively. The percentage of change in daily dose from the 1st to 10th prescription was significantly higher for pregabalin (59.2%) than for duloxetine (20.7%) (p<0.05). CONCLUSIONS: DPNP patients on duloxetine or pregabalin experienced very different dosing patterns. The average daily dose for duloxetine was relatively stable over time, while pregabalin patients had significant dose escalation over the 12-month follow-up period.