title: Significant pregabalin toxicity managed with supportive care alone.
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.
authors.affiliation: Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. David.Wood@gstt.nhs.uk
authors.forename: David M
authors.initials: DM
authors.lastname: Wood
authors.forename: David J
authors.initials: DJ
authors.lastname: Berry
authors.forename: Guy
authors.initials: G
authors.lastname: Glover
authors.forename: Jane
authors.initials: J
authors.lastname: Eastwood
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
mesh_terms: 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
chemical_list: D000700:Analgesics; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid