Possible heart failure exacerbation associated with pregabalin: case discussion and literature review

Ih, Page; Cantu, Mona; Lindenfeld, JoAnn; Hergott, Lawrence J.; Lowes, Brian D.

doi:10.2459/jcm.0b013e3282fb7629

Cited by 60 publications

(29 citation statements)

References 14 publications

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“…Discontinuation of pregabalin therapy may resolve the reaction. 46 In addition, use of pregabalin with angiotensin-converting enzyme inhibitors may increase the risk of developing angioedema of the face, mouth (lips, tongue, gums), throat, and larynx. 47 Opioids have histamine-releasing and anticholinergic properties that may produce adverse cardiovascular effects, such as hypotension or hypertension, palpitations, and sinus bradycardia.…”

Section: Cardiovascular Considerations Of Pharmacotherapy For Npmentioning

confidence: 99%

Treatment Considerations for Patients With Neuropathic Pain and Other Medical Comorbidities

Haanpää¹,

Gourlay

Kent

et al. 2010

Mayo Clinic Proceedings

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The efficacy of drugs for neuropathic pain has been established in randomized controlled trials that have excluded patients with comorbid conditions and those taking complex medications. However, patients with neuropathic pain frequently present with complex histories, making direct application of this evidence problematic. Treatment of neuropathic pain needs to be individualized according to the cause of the pain, concomitant diseases, medications, and other individual factors. Tricyclic antidepressants (TCAs), gabapentinoids, selective noradrenergic reuptake inhibitors, and topical lidocaine are the first-line choices; if needed, combination therapy may be used. When a new drug is added, screening for potential drug interactions is recommended. The TCAs have anticholinergic adverse effects and may cause orthostatic hypotension. They should be avoided or used cautiously in patients with cardiac conduction disturbances or arrhythmias. Patients who lack cytochrome P450 2D6 isoenzyme activity are prone to adverse effects of TCAs and venlafaxine and have a weaker analgesic response to tramadol. A combination of several serotoninergic drugs may lead to serotonin syndrome. Risk of gastrointestinal tract bleeding is increased in patients taking selective serotonin reuptake inhibitors or venlafaxine, especially when combined with nonsteroidal anti-inflammatory drugs. Dose adjustment may be needed in patients with renal or hepatic impairment. Depending on the drug, the dose is reduced or the dosage interval lengthened. Slow titration and careful follow-up are needed. No drug is absolutely safe during pregnancy and lactation. Particular care must be exercised during the first trimester when drug dose should be as low as possible. Individual weighing of benefits and risks should guide therapeutic decisions.Mayo Clin Proc. 2010;85(3)(suppl):S15-S25 ADR = adverse drug reaction; BP = blood pressure; CKD = chronic kidney disease; CYP = cytochrome P450; ECG = electrocardiogram; EM = extensive metabolizer; GFR = glomerular filtration rate; MI = myocardial infarction; NP = neuropathic pain; NSAID = nonsteroidal anti-inflammatory drug; OR = odds ratio; PM = poor metabolizer; RCT = randomized controlled trial; SNRI = selective noradrenergic reuptake inhibitor; TCA = tricyclic antidepressant; UM = ultrarapid metabolizer From Rehabilitation ORTON,

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Section: Cardiovascular Considerations Of Pharmacotherapy For Npmentioning

confidence: 99%

Treatment Considerations for Patients With Neuropathic Pain and Other Medical Comorbidities

Haanpää¹,

Gourlay

Kent

et al. 2010

Mayo Clinic Proceedings

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“…Pregabalin is an analog of the neurotransmitter gamma-aminobutyric acid (GABA) that has analgesic, anticonvulsant, and anxiolytic properties7). It is now widely used in the management of diabetic peripheral neuropathy, post-herpetic neuralgia, generalized anxiety disorder, and social anxiety disorder.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Syndrome of Inappropriate Antidiuretic Hormone Induced by Pregabalin

Jung

Lee

Kim

et al. 2016

Electrolyte Blood Press

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The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hyponatremia, and many medications have been associated with SIADH. Pregabalin is a drug used for the treatment of neuropathic pain, though common adverse effects include central nervous system disturbance, peripheral edema, and weight gain. However, hyponatremia caused by pregabalin has been rarely reported. Here we report a patient with pregabalin-induced hyponatremia who met the criteria for SIADH; after discontinuation of the drug, his condition rapidly improved. This case can help clinicians diagnose and treat new-onset hyponatremia in patients who recently initiated pregabalin therapy.

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“…Indeed, almost all classes of drugs commonly used to manage neuropathic pain and depression have been associated with deleterious cardiovascular effects, including anti-convulsants [30,31,32,33] (e.g., congestive heart failure), and anti-depressants [34] (e.g., heart disease). Non-traditional medications commonly used to treat pain (e.g., cannabis) may also increase the risk of CVD [35].…”

Section: Discussionmentioning

confidence: 99%

Neuropathic Pain, Depression, and Cardiovascular Disease: A National Multicenter Study

et al. 2015

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Background: Individuals with spinal cord injury (SCI) have a more than twofold increased risk of heart disease and stroke compared with able-bodied individuals. The increased risk appears to be in excess of the risk conferred by several well-established risk factors, including diabetes, hypertension, and sex. This raises the question whether other factors, secondary to SCI, are also contributing to the development of cardiovascular disease (CVD). Two potential factors associated with SCI and CVD are pain and depression. Both are frequently reported among individuals with SCI, develop in the acute stages of injury, and are commonly described as severe. Therefore, the primary aim of this study was to examine the relationship betweenpain (and types of pain) and depression with CVD among individuals with SCI. Methods: A total of 1,493 individuals (referred sample) with chronic SCI participated in a self-report cross-sectional multicenter Canada-wide survey from 2011-2012 (mean age ± standard deviation: 49.6 ± 13.9 years). Results: After adjustment for age, sex, and injury characteristics, neuropathic pain and depression were significantly and independently associated with CVD (adjusted odds ratio and 95% confidence interval: 2.27 (1.21, 4.60) for neuropathic pain; 4.07 (2.10, 7.87) for depression). In contrast to neuropathic pain, non-neuropathic pain was not significantly associated with CVD (p = 0.13). Conclusion: In conclusion, these data illustrate important interrelationships between secondary complications following SCI, as well as raise the possibility of neuropathic pain (versus nociceptive pain) as a novel and emerging risk factor for CVD.

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Possible heart failure exacerbation associated with pregabalin: case discussion and literature review

Cited by 60 publications

References 14 publications

Treatment Considerations for Patients With Neuropathic Pain and Other Medical Comorbidities

Treatment Considerations for Patients With Neuropathic Pain and Other Medical Comorbidities

A Case Report of Syndrome of Inappropriate Antidiuretic Hormone Induced by Pregabalin

Neuropathic Pain, Depression, and Cardiovascular Disease: A National Multicenter Study

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