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Abstract
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CONTEXT: Pregabalin poisoning is mostly benign, although coma and convulsions occasionally occur.
AIM: To determine the dose-toxicity relationship of pregabalin.
METHODS: Dose-toxicity data of isolated pregabalin poisonings was collected from (1) a prospective study performed by the Dutch Poisons Information Centre (4-4-2014 to 4-10-2016) and from (2) case reports and case series reported in literature. Poisonings were graded using the Poisoning Severity Score (PSS) and the relationship between dose (mgkg(-1) ) and PSS was evaluated.
RESULTS: In our study (n=21 patients), the most commonly observed symptoms were drowsiness (62%), confusion (29%), and apathy (24%). PSS was none in 3 (14%), minor in 15 (71%), and moderate in 3 patients (14%). Most case series also report a PSS of none to minor in the majority of poisonings (69% to 100%). For 34 individual patients (21 from our study and 13 from literature), detailed data on dose and clinical course were available to examine the dose-toxicity relationship. The median dose was significantly lower in the PSS none-minor group ('benign') (8.6 mgkg(-1) , IQ25-75: 5.0-17.6 mgkg(-1) ) than in the PSS moderate-severe group ('significant toxicity') (46.7 mgkg(-1) , IQ25-75: 21.3-64.3 mgkg(-1) ); estimate of the median difference = 27.3 mgkg(-1) (95% CI [10 ; 48.6]).
CONCLUSIONS: In general, higher pregabalin doses result in more severe poisonings. Below 20 mgkg(-1) the majority of patients (83%) only suffer from mild poisoning. However, large interindividual differences exist in pregabalin-induced toxicity. Therefore, pre-hospital triage should not only include pregabalin dose, but also underlying illnesses, co-exposures and reported symptoms.
Language: en |