Treatment of Pregabalin Toxicity by Hemodialysis in a Patient With Kidney Failure

• Published in: American journal of kidney diseases Vol. 54; no. 6; pp. 1127 - 1130
• Main Authors: Yoo, Lawrence, MD, Matalon, Daniel, MD, Hoffman, Robert S., MD, Goldfarb, David S., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-2009; Elsevier
• Subjects: 3-Isobutyl γ-aminobutyric acid (GABA); Adult; Analgesics - blood; Analgesics - poisoning; Analgesics - therapeutic use; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Dose-Response Relationship, Drug; Emergency and intensive care: renal failure. Dialysis management; Female; gabapentin; gamma-Aminobutyric Acid - analogs & derivatives; gamma-Aminobutyric Acid - blood; gamma-Aminobutyric Acid - poisoning; gamma-Aminobutyric Acid - therapeutic use; Humans; Intensive care medicine; intoxication; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - therapy; Lyrica; Medical sciences; Nephrology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Neuralgia - drug therapy; poisoning; Pregabalin; Renal Dialysis; Renal failure; Time Factors; Treatment Outcome; γ-aminobutyric acid; poisoning; gabapentin; γ-aminobutyric acid; 3-Isobutyl γ-aminobutyric acid (GABA); Lyrica; intoxication; renal dialysis; Nephrology; Gabapentin; Hemodialysis; Toxicity; Anticonvulsant; Pregabalin; Kidney; Urology; Extrarenal dialysis; Kidney disease; Human; Urinary system disease; 3-lsobutyl γ-aminobutyric acid (GABA); Analgesic; Treatment; Urinary system; Acids; Renal failure; Neurotransmitter; GABA; Dialysis; Poisoning
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2009.04.014

Pregabalin is prescribed for neuropathic pain. We report the first case of pregabalin toxicity in a hemodialysis patient and her successful treatment with hemodialysis. The patient was a 30-year-old woman on long-term hemodialysis therapy who experienced significant myoclonus of the arms and legs when her dose of pregabalin was mistakenly increased. The drug has 3 properties that contribute to making it amenable to removal by hemodialysis: relatively low molecular weight (159.23 Da), relatively low volume of distribution (0.5 L/kg), and not bound to plasma proteins. We achieved hemodialysis clearance of 88.8 mL/min, which was associated with resolution of symptoms immediately after hemodialysis.