pregabalin

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Reactions 1215 - 16 Aug 2008 Pregabalin Decompensation of heart failure: 3 case reports Three men with chronic heart failure and left ventricular dysfunction developed a decompensation of heart failure during treatment with pregabalin [dosages not stated]. See table for concomitant medication. Patient details and concomitant drugs Patient/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-inhibitor and angiotensin receptor antagonist therapy, and stable heart failure status for 6 months, started receiving pregabalin for neuropathic pain related to diabetes mellitus. Over the next 4 weeks, he developed increasing dyspnoea and gained weight. Examination showed raised jugular venous pressure, clear lung fields and pitting ankle oedema. He had an increased B-type natriuretic peptide (BNP) level of 611 pg/mL (baseline 293 pg/mL). Pregabalin was discontinued and he was prescribed an increase in oral diuretic. Three days later, his dyspnoea continued and paroxysmal nocturnal dyspnoea had developed. He received IV furosemide 60mg stat. He showed good symptomatic improvement and lost 5.8kg over the following days, and remained well. Patient 2, who had stable heart failure status for 1 year, started receiving pregabalin for diabetes-related peripheral neuropathy. Over the next 2 months, he developed increasing dyspnoea and noticed a weight increase. Examination showed confirmatory evidence of heart failure. Pregabalin was discontinued, without improvement. His oral diuretics were increased and his symptoms improved, he lost 3kg and there was 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. His clinical status deteriorated over the next 4 weeks. Symptoms of biventricular heart failure developed, associated with significant 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 and increased oral diuretics. His symptoms improved, he lost 5.8kg and his BNP level decreased to 561 pg/mL over the next 2 weeks. Author comment: "[W]e report 3 cases of patients with likely acute decompensation of established chronic heart failure after initiation of Pregabalin for neuropathic pain." Murphy N, et al. Decompensation of chronic heart failure associated with pregabalin in patients with neuropathic pain. Journal of Cardiac Failure 13: 227-229, No. 3, Apr 2007 - Ireland 801117384 1 Reactions 16 Aug 2008 No. 1215 0114-9954/10/1215-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Page 1: Pregabalin

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