Gabapentin induces edema, hyperesthesia and scaling in a depressed patient; a diagnostic challenge

Abstract

Gabapentin is a common drug used as analgesic and anticonvulsant and also is prescribed for insomnia, depression, obsessive – compulsive disorder and panic attack. We report a case of a 48-year-old man who is prescribed gabapentin because of insomnia, headache, and depressed mood. In the first period of using the drug no complication has been seen. However in the next period, side-effects such as hyperesthesia, scaling and severe localized edema has been observed. After several laboratory tests and imaging, no reason was found for his edema. And after discontinuing gabapentin the pain and edema was quite relieved. We found out the brand of the drug has been switched in the second stage. The point which makes our study special is the incidence of side-effects such as severe edema, scaling and hyperesthesia for the first time because of using gabapentin and changing the drug combination.

Gabapentinoids for Pruritus in Older Adults: A Narrative Review

“…Older age was associated with an increased incidence of peripheral edema (seen in trials for both Neurontin and Gralise [ 28 , 30 ]) and ataxia (seen in trials for Neurontin [ 28 ]); this association was not seen in trials for pregabalin [ 29 ]. Peripheral edema has been observed in several randomized control trials for gabapentin [ 38 ], and case reports suggest that this finding can be observed within days to 2 weeks of initiation [ 39 – 41 ]. Providers should counsel patients on this possible reaction in advance of gabapentin initiation so that patients are not alarmed if peripheral edema does develop.…”

Gabapentin-induced bilateral lower extremity edema in a patient with pervasive developmental disorder and schizoaffective disorder

“…Gabapentin was discontinued, and his edema improved over the next few days. The final case, reported by Bidaki et al, 11 described a 48-year-old male with depression and insomnia who experienced severe localized edema that resolved upon discontinuation of gabapentin 300 mg at bedtime.…”

“…Peripheral edema from gabapentin is not always dose related, however. There are 3 published case reports 6 , 7 , 11 of patients who developed peripheral edema at doses lower than 1800 mg/d. One case published by Kanbay et al 6 described peripheral edema related to gabapentin in a 76-year-old male.…”

“… 1 , 4 Although gabapentin is generally well tolerated, 1 reported potential adverse effect is peripheral edema. 4 - 11 However, due to the extensive number of etiologies of peripheral edema, medication causes may be overlooked on an inpatient psychiatric unit. This is a case of painful, 4+ pitting bilateral edema with a probable association to gabapentin (Naranjo score 5) and a clear dose relationship in a patient with pervasive developmental disorder and schizoaffective disorder utilizing gabapentin for mood stabilization.…”

Valproate-Induced Lower Extremity Swelling

“…Other medications commonly used in seizure management (such as benzodiazepines and gabapentin) have been reported to cause new onset peripheral edema. 5,8…”