Reactions 1215 - 16 Aug 2008

Pregabalin

Decompensation of heart failure: 3 case reportsThree men with chronic heart failure and left ventricular

dysfunction developed a decompensation of heart failureduring treatment with pregabalin [dosages not stated]. Seetable for concomitant medication.

Patient details and concomitant drugsPatient/age Concomitant medications(years)

1/69 Furosemide, bisoprolol, nitroglycerin patch,eplerenone, atorvastatin, lansoprazole, insulin,diltiazem, nicorandil

2/59 Bumetamide, perindopril, metoprolol, digoxin,warfarin, pravastatin, insulin, metformin

3/72 Losartan, carvedilol, digoxin, nitrate patch [sic],furosemide, warfarin

Patient 1, who had a history of intolerance to ACE-inhibitorand angiotensin receptor antagonist therapy, and stable heartfailure status for 6 months, started receiving pregabalin forneuropathic pain related to diabetes mellitus. Over the next4 weeks, he developed increasing dyspnoea and gainedweight. Examination showed raised jugular venous pressure,clear lung fields and pitting ankle oedema. He had an increasedB-type natriuretic peptide (BNP) level of 611 pg/mL (baseline293 pg/mL). Pregabalin was discontinued and he wasprescribed an increase in oral diuretic. Three days later, hisdyspnoea continued and paroxysmal nocturnal dyspnoea haddeveloped. He received IV furosemide 60mg stat. He showedgood symptomatic improvement and lost 5.8kg over thefollowing days, and remained well.

Patient 2, who had stable heart failure status for 1 year,started receiving pregabalin for diabetes-related peripheralneuropathy. Over the next 2 months, he developed increasingdyspnoea and noticed a weight increase. Examination showedconfirmatory evidence of heart failure. Pregabalin wasdiscontinued, without improvement. His oral diuretics wereincreased and his symptoms improved, he lost 3kg and therewas a resolution of all clinical signs of heart failure.

Patient 3, who had stable heart failure status for 4 months,started receiving pregabalin for paraesthesia in his feet. Hisclinical status deteriorated over the next 4 weeks. Symptomsof biventricular heart failure developed, associated withsignificant weight gain. He also reported ataxia and dry mouth.He had a BNP level of 2110 pg/mL (baseline 461 pg/mL).Pregabalin was stopped and he received IV diuretics andincreased oral diuretics. His symptoms improved, he lost5.8kg and his BNP level decreased to 561 pg/mL over the next2 weeks.

Author comment: "[W]e report 3 cases of patients withlikely acute decompensation of established chronic heartfailure after initiation of Pregabalin for neuropathic pain."Murphy N, et al. Decompensation of chronic heart failure associated withpregabalin in patients with neuropathic pain. Journal of Cardiac Failure 13:227-229, No. 3, Apr 2007 - Ireland 801117384

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Reactions 16 Aug 2008 No. 12150114-9954/10/1215-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved