Journal of Acute Care

Register      Login

VOLUME 3 , ISSUE 1 ( January-April, 2024 ) > List of Articles

TUTORIAL

Pregabalin-associated Pulmonary Thromboembolism

Rishika Jandial, Ranjitha Raj

Keywords : Breathlessness, Neuropathy, Pregabalin, Pulmonary thromboembolism

Citation Information : Jandial R, Raj R. Pregabalin-associated Pulmonary Thromboembolism. 2024; 3 (1):44-48.

DOI: 10.5005/jp-journals-10089-0089

License: CC BY-NC 4.0

Published Online: 30-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Pregabalin is a commonly prescribed medicine for the treatment of diabetic neuropathy. The adverse effect of this drug on long-term use remains unknown. This is a case of a 47-year-old female who presented to hospital with a history of shortness of breath. She was a known case of with diabetic neuropathy receiving pregabalin 75 mg orally once a day. The patient had a heart rate of 112 beats/minute, blood pressure of 102/52 mm Hg, respiratory rate of 28/minute, peripheral oxygenation saturation of 88% on room air, and D-dimer of 2.29 mg/L. Transthoracic echocardiography [two-dimensional (2D)] showed paradoxical motion of intraventricular septum (IVS), elevation in pulmonary artery systolic pressure (50 mm Hg), mild right atrial/right ventricular (RA/RV) dilatation and normal left ventricular (LV) systolic function. Chest X-ray suggestive of left middle zone haziness. Computed tomography of pulmonary angiogram (CTPA) showed a thrombus at the left main pulmonary artery. The other risk factors for pulmonary embolism (PE) were absent. Hence, a diagnosis of acute pulmonary thromboembolism (PTE) secondary to drug-induced (pregabalin) was made and managed with tenecteplase, heparin, and later rivaroxaban. The patient improved and was discharged home in hemodynamically stable condition. This case report highlights a case of pregabalin-associated PTE. Early diagnosis and management can reduce morbidity and mortality.


PDF Share
  1. Pan Y, Davis PB, Kaebler DC. Cardiovascular risk of gabapentin and pregabalin in patients with diabetic neuropathy. Cardiovasc Diabetol 2022;21(170):1–9. DOI: 10.1186/s12933-022-01610-9
  2. FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin and pregabalin. U.S. Food and Drug. Administration (FDA). 2019. p. 3784.
  3. Lowe D (March 25, 2008). “Getting to Lyrica”. In the Pipeline. Science. Archived from the original on August 27, 2022. Retrieved November 21, 2015.
  4. Calandre EP, Rico-Villademoros F, Slim M. Alpha2 delta 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
  5. Uchitel OD, Di Guilmi MN, Urbano FJ, et al. Acute modulation of calcium currents and synaptic transmission by gab apentinoids. Channels 2010;4(6):490–496. DOI: 10.4161/chan.4.6.12864
  6. Li Z, Taylor CP, Weber M, et al. Pregabalin is a potent and selective ligand for α (2)δ-1 and α (2)δ-2 calcium channel subunits. Eur J Pharmacol 2011;667(1–3):80–90. DOI: 10.1016/j.ejphar.2011.05.054
  7. Sze PY. L-Glutamate decarboxylase. Adv Exp Med Biol 1979;123:59–78. DOI: 10.1007/978-1-4899-5199-1_4
  8. Geldenhuys WJ, Mohammad AS, Adkins CE, et al. Molecular determinants of blood-brain barrier permeation. Ther Deliv 2015;6(8):961–971. DOI: 10.4155/tde.15.32
  9. Müller CE. Prodrug approaches for enhancing the bioavailability of drugs with low solubility. Chem Biodivers 2009;6(11):2071–2083. DOI: 10.1002/cbdv.200900114
  10. Bockbrader HN, Radulovic LL, Posvar EL, et al. Clinical pharmacokinetics of pregabalin in healthy volunteers. J Clin Pharmacol 2010;50(8):941–950. DOI: 10.1177/0091270009352087
  11. Attal N, Cruccu G, Baron R, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010;17(9): e1113–e1188. DOI: 10.1111/j.1468-1331.2010.02999.x
  12. Calandre EP, Garcia-Leiva JM, Rico-Villademoros F, et al. Pregabalin in the treatment of chronic migraine: an open-label study. Clin Neuropharmacol 2010;33(1):35–39. DOI: 10.1097/WNF.0b013e3181bf1dbe
  13. Murphy N, Mockler M, Ryder M, et al. Decompensation of chronic heart failure associated with pregabalin in patients with neuropathic pain. J Cardiac Fail 2007;13(3):227–229. DOI: 10.1016/j.cardfail.2006.11.006
  14. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020;141(9):e139– e596. DOI: 10.1161/CIR.0000000000000757
  15. Turetz M, Sideris AT, Friedman OA, et al. Epidemiology, pathophysiology, and natural history of pulmonary embolism. Semin Intervent Radiol 2018;35(2):92–98. DOI: 10.1055/s-0038-1642036
  16. Girard P, Musset D, Parent F, et al. High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism. Chest 1999;116(4):903–908. DOI: 10.1378/chest.116.4.903
  17. Previtali E, Bucciarelli P, Passamonti SM, et al. Risk factors for venous and arterial thrombosis. Blood Transfus 2011;9(2):120–138. DOI: 10.2450/2010.0066-10
  18. Klok FA, Huisman MV. Management of incidental pulmonary embolism. Eur Respir J 2017;49(6):1700275. DOI: 10.1183/13993003.00275-2017
  19. Agnelli G, Becattini C. Acute pulmonary embolism. N Engl J Med 2010;363(3):266–274. DOI: 10.1056/NEJMra0907731
  20. Carrier M, Righini M, Djurabi RK, et al. VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism: a systematic review of management outcome studies. Thromb Haemost 2009;101(5):886–892.
  21. van Es N, van der Hulle T, van Es J, et al. Wells rule and D-dimer testing to rule out pulmonary embolism: a systematic review and individual-patient data meta-analysis. Ann Intern Med 2016;165(4):253–261. DOI: 10.7326/M16-0031
  22. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 2006;144(3):165–171. DOI: 10.7326/0003-4819-144-3-200602070-00004
  23. Wolf SJ, McCubbin TR, Feldhaus KM, et al. Prospective validation of Wells criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med 2004;44(5):503–510. DOI: 10.1016/j.annemergmed.2004.04.002
  24. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020;41(4):543–603. DOI: 10.1093/eurheartj/ehz405
  25. Jackson CD, Cifu AS, Burroughs-Ray DC. Antithrombotic therapy for venous thromboembolism. JAMA 2022;327(21):2141–2142. DOI: 10.1001/jama.2022.7325
  26. Kaufman JA, Barnes GD, Chaer RA, et al. Society of Interventional Radiology Clinical Practice Guideline for inferior vena cava filters in the treatment of patients with venous thromboembolic disease: developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine. J Vasc Interv Radiol 2020;31(10):1529–1544. DOI: 10.1016/j.jvir.2020.06.014
  27. Corsi F, Lebreton G, Bréchot N, et al. Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation. Crit Care 2017;21(1):76. DOI: 10.1186/s13054-017-1655-8
  28. Stevens SM, Woller SC, Baumann Kreuziger L, et al. Executive summary: antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest 2021;160(6):2247–2259. DOI: 10.1016/j.chest.2021.07.056
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.