The Poison Review

Abstract

TREATMENT OF PREGABALIN TOXICITY BY HEMODIALYSIS IN A PATIENT WITH KIDNEY FAILURE Yoo L et al.   Am J Kidney Dis Dec 2009;54:1127-30.

Pregabalin (Lyrica) is an anticonvulsant also used to treat diabetic neuropathy, post-herpetic neurolagia, and fibromyalgia.  This case report describe a dialysis patient who developed signs of mild pregabalin toxicity — myoclonus and muscular contractions — after having her dosage of the drug tripled.  Because pregabalin has a low molecular weight, a small volume of distribution, and is not bound to plasma proteins, the patient was treated with hemodialysis and had immediate improvement of symptoms.  Pharmacokinetic data cited in the article demonstrates that clearance of the drug by dialysis was successful.

The common adverse effects of pregabalin are mild: dizziness, drowsiness, tremor, and ataxia.  The drug is eliminated primarily by the kidneys, and severe toxicity is unlikely to be an issue except in cases of renal failure or possibly massive overdose.  This paper makes the point that while hemodialysis can effectively enhance the elimination of pregabalin, in most cases it will not be needed.