Flumazenil and dialysis for gabapentin-induced coma.
OBJECTIVE
To describe a case of gabapentin-induced coma that was reversed with flumazenil and hemodialysis.


METHODS
We describe an 83-year-old dialysis-dependent white man who became comatose after a single dose of gabapentin for phantom limb pain. The patient was successfully revived from the coma with administration of flumazenil, which was then followed by hemodialysis. Serum concentration data before and 4 hours after dialysis document the effectiveness of hemodialysis for gabapentin toxicity.


CONCLUSIONS
An objective causality assessment revealed that this adverse event was probably related to the gabapentin that the patient received. To our knowledge, this is the first documented case of not only gabapentin-induced coma, but also the effectiveness of flumazenil for treatment of this type of coma. Although therapeutic hemodialysis has been previously described, our case report is strengthened by the serum concentration monitoring accompanying it.


CONCLUSIONS
This report underscores the importance of initiating gabapentin therapy at low doses in dialysis-dependent patients and introduces a novel treatment for those who experience toxicity.
Butler
Toni C
TC
Department of Surgery, Bassett Healthcare, Cooperstown, NY 13326-1394, USA.
Rosen
Raquel M
RM
Wallace
Allison L
AL
Amsden
Guy W
GW
D000085:Acetates / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D000588:Amines; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects*; D000931:Antidotes / Q000627:therapeutic use*; D003128:Coma / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy*; D003509:Cyclohexanecarboxylic Acids; D005442:Flumazenil / Q000627:therapeutic use*; D000077206:Gabapentin; D006801:Humans; D008297:Male; D010591:Phantom Limb / Q000188:drug therapy; D006435:Renal Dialysis; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D000700:Analgesics; D000931:Antidotes; D003509:Cyclohexanecarboxylic Acids; D005442:Flumazenil; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin