Myoclonus Developing After High-Dose Pregabalin Intake: A Rare Clinical Case

Öz

Introduction: Pregabalin has become a widely prescribed drug worldwide in recent years. There has been an increase in its accidental, suicidal, and even abusive use. It induces anxiolytic, sedative, or euphoric effects when taken together with substances such as alcohol. Although it has many side effects, it may also cause neurological side effects. Here, a 17-year-old male patient who had myoclonic seizures after taking high doses of pregabalin with alcohol without any known additional drug intake is presented because it is a rare clinical finding. Case Report: A 17-year-old male patient was brought to the emergency department due to a fall after drinking alcohol. His triage vital signs were stable. GCS was 15. In the 30th minute of his emergency, the patient had myoclonic jerks in his arms and legs, and their frequency began to increase. The patient's history was questioned again. His brother stated that the patient may have taken pregabalin. The patient stated that he had taken seven pregabalin pills (1 pill = 300 mg) with alcohol. In laboratory tests, there was no pathology other than respiratory acidosis. COHb: 7.2, Lactate: 7. Blood ethanol level was 10 mg/dL. Cranial and cervical tomography were normal. Serum pregabalin level was determined as 300 mg/L by the LC-MSMS method in the reference hospital. Other toxic analyses were negative. The patient was discharged after one day of supportive treatment. Conclusion: Alcohol and high-dose pregabalin intake may rarely lead to the development of neurological side effects such as myoclonus. Given the increasing prescription rates, pregabalin poisoning and related clinical findings will be frequently seen in emergency departments. Therefore, especially in cases with alcohol consumption, additional medication intake should be questioned, pregabalin exposure should be considered, and appropriate management strategies should be implemented.

Anahtar Kelimeler

• alkol
• pregabalin
• myoklonus

Myoclonus Developing After High-Dose Pregabalin Intake: A Rare Clinical Case

Öz

Abstract: Introduction: Pregabalin has become a widely prescribed drug worldwide in recent years. There has been an increase in its accidental, suicidal, and even abusive use. It induces anxiolytic, sedative, or euphoric effects when taken together with substances such as alcohol. Although it has many side effects, it may also cause neurological side effects. Here, a 17-year-old male patient who had myoclonic seizures after taking high doses of pregabalin with alcohol without any known additional drug intake is presented because it is a rare clinical finding. Case Report: A 17-year-old male patient was brought to the emergency department due to a fall after drinking alcohol. His triage vital signs were stable. GCS was 15. In the 30th minute of his emergency, the patient had myoclonic jerks in his arms and legs, and their frequency began to increase. The patient's history was questioned again. His brother stated that the patient may have taken pregabalin. The patient stated that he had taken seven pregabalin pills (1 pill = 300 mg) with alcohol. In laboratory tests, there was no pathology other than respiratory acidosis. COHb: 7.2, Lactate: 7. Blood ethanol level was 10 mg/dL. Cranial and cervical tomography were normal. Serum pregabalin level was determined as 300 mg/L by the LC-MSMS method in the reference hospital. Other toxic analyses were negative. The patient was discharged after one day of supportive treatment. Conclusion: Alcohol and high-dose pregabalin intake may rarely lead to the development of neurological side effects such as myoclonus. Given the increasing prescription rates, pregabalin poisoning and related clinical findings will be frequently seen in emergency departments. Therefore, especially in cases with alcohol consumption, additional medication intake should be questioned, pregabalin exposure should be considered, and appropriate management strategies should be implemented.

Anahtar Kelimeler

• alcohol
• pregabalin
• myoclonus

Kaynakça

1. 1. Evoy KE, Morrison MD, Saklad SR. Abuse and misuse of pregabalin and gabapentin. Drugs. 2017; 77: 403-426. doi:10.1007/s40265-017-0700-x.
2. 2. Calandre EP, Rico-Villademoros F, Slim M. Alpha2delta ligands, gabapentin, pregabalin and mirogabalin: a review of their clinical pharmacology and therapeutic use. Expert Rev Neurother. 2016;16(11): 1263-1277.doi: 10.1080/14737175.2016.1202764.
3. 3. AC Pande, DE Feltner, JW Jefferson, et al. Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebocontrolled, multicenter study. J Clin Psychopharmacol 2004; 24:141–149. doi: 10.1097/01.jcp.0000117423.05703.e7.
4. 4. Ben-Menachem E. Pregabalin pharmacology and its relevance to clinical practice. Epilepsia. 2004;45:13-18. doi: 10.1111/j.0013-9580.2004.455003.x.
5. 5. Caviness JN, Truong DD. Myoclonus. Handb Clin Neurol 2011:100:399-420. doi: 10.1016/B978-0-444-52014-2.00031-8.
6. 6. Jiménez-Jiménez FJ, Puertas I, de Toledo-Heras M. Drug-induced myoclonus: frequency, mechanisms and management. CNS Drugs 2004; 18:93-104. doi: 10.2165/00023210-200418020-00003.
7. 7. Desai A, Kherallah Y, Szabo C, Marawar R. Gabapentin or pregabalin induced myoclonus: A case series and literature review. J Clin Neurosci 2019; 61:225-234. doi: 10.1016/j.jocn.2018.09.019.
8. 8. Isoardi KZ, Polkinghorne G, Harris K, Isbister GK. Pregabalin poisoning and rising recreational use: a retrospective observational series. Br J Clin Pharmacol 2020; 86:2435-2440. doi: 10.1111/bcp.14348. Epub 2020 Jun 5.

9. 9. Reedy SJD, Schwartz MD. A case series of recreational pregabalin overdose resulting in generalized seizures [abstract]. Clin Toxicol 2010; 18:616-617.
10. 10. Holtkamp M, Halle A, Meierkord H, Masuhr F. Gabapentin-induced severe myoclonus in a patient with impaired renal function. J Neurol 2006; 253:382-383. doi: 10.1007/s00415-005-0970-1.
11. 11. Bucur M, Jeczmien P. Pregabalin and libido-case reports. Open Neuropsychopharmacol J 2011; 4: 8-9.
12. 12. Al-Husseini A, Wazaify M, Van Hout MC. Pregabalin misuse and abuse in Jordan: A qualitative study of user experiences. Int J Ment Health Addict 2018; 16: 642-654. doi: 10.1007/ s11469-017-9813-4.
13. 13. Baird CR, Fox P, Colvin LA. Gabapentinoid abuse in order to potentiate the effect of methadone: a survey among substance misusers. Eur Addict Res 2014; 20: 115-118.doi: 10.1159/000355268.
14. 14. Schifano F, D’Offizi S, Piccione M, et al. Is there a recreational misuse potential for pregabalin? Analysis of anecdotal online reports in comparison with related gabapentin and clonazepam data. Psychother Psychosom 2011; 80: 118-122. doi: 10.1159/000321079.
15. 15. Papazisis G, Garyfallos G, Sardeli C, Kouvelas D. Pregabalin abuse after past substance-seeking behavior. Int J Clin Pharmacol Ther 2013; 51: 441-442. doi: 10.5414/CP201881.
16. 16. Yazdi K, Hemetsberger U, Baier C. Pregabalin abuse of benzodiazepine and alcohol addicted patient. Psychiatr Danub 2015; 27: 278-279.
17. 17. Yoo L, Matalon D, Hoffman RS, Goldfarb DS (2009) Treatment of pregabalin toxicity by haemodialysis in a patient with kidney failure. Am J Kidney Dis 54:1127–1130. doi: 10.1053/j. ajkd.2009.04.014.
18. 18. Wood, D.M., Berry, D.J., Glover, G. et al. Significant Pregabalin Toxicity Managed with Supportive Care Alone. J. Med. Toxicol. 2010; 6:435–437. https://doi.org/10.1007/s13181-010-0052-3