Abstract
There are two previously reported cases describing the management of pregabalin self-poisoning and one further case of management of therapeutic pregabalin accumulation. The peak reported pregabalin concentrations in these cases ranged from 13 mg/L to approximately 60 mg/L. Previous case reports have suggested that both supportive care and enhanced elimination are appropriate managements for pregabalin toxicity. A 54-year-old male presented following ingestion of 8.4 g of pregabalin. Initially, he had no clinical features of toxicity, although he developed significant neurological depression and coma approximately 3 h post-ingestion. He was managed with supportive care (including endotracheal intubation and mechanical ventilation) until his level of consciousness improved. Subsequent toxicological screening confirmed isolated pregabalin ingestion, with a serum pregabalin concentration of 66.5 mg/L at the time he clinically deteriorated. The pharmacokinetic properties of pregabalin indicate the potential value of extra-corporeal elimination methods such as haemodialysis. Clinical toxicologists should be aware that whilst there is a pharmacokinetic basis for the use of extra-corporeal methods in those with severe toxicity arising from excessive plasma pregabalin concentrations, there are case reports, including this one, where patients have been managed with supportive measures only.
Keywords: Pregabalin, Toxicity, Overdose
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References
- 1.Olaizola I, Ellger T, Young P, Boseback F, Evers S, Kellinghaus C. Pregabalin-associated acute psychosis and epileptiform EEG-changes. Seizure. 2006;15:208–221. doi: 10.1016/j.seizure.2006.02.004. [DOI] [PubMed] [Google Scholar]
- 2.Huppertz HJ, Feuerstein TJ, Schulze-Bonhage A. Myoclonus in epilepsy patients with anticonvulsive add-on therapy with pregabalin. Epilepsia. 2001;42:790–792. doi: 10.1046/j.1528-1157.2001.44000.x. [DOI] [PubMed] [Google Scholar]
- 3.Braga AJ, Chidley K. Self-poisoning with lamotrigine and pregabalin. Anaesthesia. 2007;62:524–527. doi: 10.1111/j.1365-2044.2006.04913.x. [DOI] [PubMed] [Google Scholar]
- 4.Spiller HA, Bratcher R, Griffiths JRK. Pregabalin overdose with benign outcome. Clin Tox. 2008;46:917. doi: 10.1080/15563650801986497. [DOI] [PubMed] [Google Scholar]
- 5.Yoo L, Matalon D, Hoffman RS, Goldfarb DS. Treatment of pregabalin toxicity by haemodialysis in a patient with kidney failure. Am J Kidney Dis. 2009;54:1127–1130. doi: 10.1053/j.ajkd.2009.04.014. [DOI] [PubMed] [Google Scholar]
- 6.American Association of Poison Control Centers. Annual data reports. http://www.aapcc.org/dnn/NPDSPoisonData/AnnualReports/tabid/125/Default.aspx. Last accessed 1 Feb 2010
- 7.Berry D, Millington C. Analysis of pregabalin at therapeutic concentrations in human plasma/serum by reversed phase HPLC. Ther Drug Monit. 2005;27:451–456. doi: 10.1097/01.ftd.0000158874.54100.1a. [DOI] [PubMed] [Google Scholar]
- 8.French JA, Kugler AR, Garafalo EA, Robbins JL, Anhut H, Messmer S. Pregabalin dose-response in patients with partial seizures as evaluated in two add-on trials. Epilepsia. 2001;42(suppl. 2):36. [Google Scholar]
- 9.Pfizer Limited. Lyrica capsules—summary of product characteristics. Pfizer Limited, UK. http://emc.medicines.org.uk/document.aspx?documentId=14651. Last accessed 1 Feb 2010
- 10.Lofton AL, Klein-Schwartz W. Evaluation of lamotrigine toxicity reported to poison centers. Ann Pharmacother. 2004;38:1811–1815. doi: 10.1345/aph.1E192. [DOI] [PubMed] [Google Scholar]
- 11.Burstein AH. Lamotrigine. Pharmacotherapy. 1995;15:129–143. [PubMed] [Google Scholar]
- 12.Besag FM, Craven P, Berry DJ, Pool F, Aylett S. The role of blood-level monitoring in assessing lamotrigine toxicity. Epilepsia. 1998;39(Suppl. 6):131. [Google Scholar]