Pregabalin poisoning and rising recreational use: a retrospective observational series. Issue 12 (5th June 2020)

• Record Type: Journal Article
• Authors: Isoardi, Katherine Z.; Polkinghorne, Gregory; Harris, Keith; Isbister, Geoffrey K.
• Is Part Of: British journal of clinical pharmacology. Volume 86:Issue 12(2020)
• Page Start: 2435
• Page End: 2440
• Publication Date: 2020-06-05
• Subjects: drug abuse -- overdose and poisoning -- toxicology; Pharmacology -- Periodicals; Drugs -- Periodicals; 615.1
• DOI: 10.1111/bcp.14348
• Languages: English
• ISSNs: 0306-5251

Abstract

Abstract : Aims: With rising use worldwide, pregabalin is increasingly implicated in poisoning deaths. We aimed to investigate the clinical effects and complications of pregabalin poisoning. Methods: This is a retrospective review of patients presenting with pregabalin poisoning to two tertiary toxicology units from 1 July 2014 to 30 June 2019. Patients were identified from prospective databases maintained by both units and data were extracted from these in addition to medical records. Results: There were 488 presentations in 413 patients (237 [57%] male) over the five‐year period. The median age was 41 years (IQR 31–50 years). Deliberate self‐poisonings accounted for 342 (70%) presentations, with 121 (25%) recreational exposures. Recreational exposures increased over the period from 2 (4%) in the first year to 54 (39%) presentations in the final year. The median dose of pregabalin was 1200 mg (IQR 600‐3000 mg, range 75‐16 800 mg). Co‐ingestions occurred in 427 (88%) presentations, with sedating agents being co‐ingested in 387 (79%)—most commonly opioids and benzodiazepines in 201 (41%) and 174 (36%) presentations respectively. Coma (GCS < 9) occurred in 89 (18%) cases, with 52 (11%) patients being intubated. Only one (0.2%) of these patients had not co‐ingested a sedating agent. Hypotension occurred in 26 (5%) cases, all with co‐ingestants. Seizures occurred in 11 (2%) cases, 3/59 (5%) in pregabalin‐only overdoses. The median length of stay was 16.5 hours (IQR 10–25 hours). Conclusions: Pregabalin overdose does not cause severe toxicity, but rather mild sedation and, uncommonly, seizures. Coma is common in the presence of sedating co‐ingestants. Recreational use is increasing.