Significant Pregabalin Toxicity Managed with Supportive Care Alone
Significant Pregabalin Toxicity Managed with Supportive Care Alone
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DOI：
10.1007/s13181-010-0052-3
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发表时间：
2010-12-01
影响因子：
2.9
通讯作者：
Dargan, Paul, I
中科院分区：
文献类型：
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作者：
Wood, David M.;Berry, David J.;Dargan, Paul, I
有两个先前报告的病例描述了普瑞巴林自我中毒的管理，还有一个病例描述了治疗性普瑞巴林蓄积的管理。这些病例中报告的普瑞巴林峰浓度范围为13 mg/L至约60 mg/L。之前的病例报告表明，支持性护理和加强消除都是普瑞巴林毒性的适当管理方法。一名54岁男性在摄入8.4 g普瑞巴林后就诊。最初，他没有毒性的临床特征，尽管他在摄入后约3小时出现了显著的神经抑郁和昏迷。患者接受支持性护理（包括气管插管和机械通气），直至意识水平改善。随后的毒理学筛查证实了单独的普瑞巴林摄入，在他临床恶化时血清普瑞巴林浓度为66.5 mg/L。普瑞巴林的药代动力学特性表明了皮质醇外消除方法（如血液透析）的潜在价值。临床毒理学家应该意识到，虽然在血浆普瑞巴林浓度过高引起严重毒性的患者中使用皮质醇外给药方法有药代动力学基础，但也有病例报告（包括本例）仅对患者进行了支持性治疗。
There are two previously reported cases describing the management of pregabalin self-poisoning and one further case of management of therapeutic pregabalin accumulation. The peak reported pregabalin concentrations in these cases ranged from 13 mg/L to approximately 60 mg/L. Previous case reports have suggested that both supportive care and enhanced elimination are appropriate managements for pregabalin toxicity. A 54-year-old male presented following ingestion of 8.4 g of pregabalin. Initially, he had no clinical features of toxicity, although he developed significant neurological depression and coma approximately 3 h post-ingestion. He was managed with supportive care (including endotracheal intubation and mechanical ventilation) until his level of consciousness improved. Subsequent toxicological screening confirmed isolated pregabalin ingestion, with a serum pregabalin concentration of 66.5 mg/L at the time he clinically deteriorated. The pharmacokinetic properties of pregabalin indicate the potential value of extra-corporeal elimination methods such as haemodialysis. Clinical toxicologists should be aware that whilst there is a pharmacokinetic basis for the use of extra-corporeal methods in those with severe toxicity arising from excessive plasma pregabalin concentrations, there are case reports, including this one, where patients have been managed with supportive measures only.