Significant pregabalin toxicity managed with supportive care alone.
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.
Wood
David M
DM
Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. David.Wood@gstt.nhs.uk
Berry
David J
DJ
Glover
Guy
G
Eastwood
Jane
J
Dargan
Paul I
PI
D000700:Analgesics / Q000506:poisoning*; D062787:Drug Overdose / Q000628:therapy; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000209:etiology* / Q000628:therapy; D010166:Palliative Care; D011041:Poisoning / Q000209:etiology* / Q000628:therapy; D000069583:Pregabalin; D012121:Respiration, Artificial; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000506:poisoning
D000700:Analgesics; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid