Pierce Dwayne A, Holt Shea R, Reeves-Daniel Amber
Department of Pharmacy, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA.
Clin Ther. 2008 Sep;30(9):1681-4. doi: 10.1016/j.clinthera.2008.09.004.
As described in the literature, gabapentin toxicity in patients with impaired renal function can manifest as coma, myoclonus, tremulousness, or altered mental status. Gabapentin is an antiepileptic agent indicated for use as an adjunct therapy in partial seizures and postherpetic neuralgia but is also prescribed for the treatment of diabetic peripheral neuropathy.
A 46-year-old white woman (height, 167 cm; weight, 177 kg; body mass index, 62.8 kg/m2) with a 6-year history of diabetes mellitus and previously normal renal function, presented to the emergency department of Wake Forest University Baptist Medical Center with anuria (a serum creatinine level of 7.4 mg/dL), hearing loss, myoclonus, and confusion with hallucinations lasting for 3 days. Her blood pressure was 110/74 mm Hg. The patient's preadmit medication list included: lisinopril (40 mg QD), hydrochlorothiazide (25 mg QD), and furosemide (80 mg QD) for hypertension; atorvastatin (10 mg QD) for hyperlipidemia; omeprazole (20 mg QD) for gastroesophageal reflux disease; salmeterol/fluticasone inhaler (100/50 microg; 1 puff BID) and albuterol metered-dose inhaler (90 microg as needed) for asthma; metformin (500 mg BID) and insulin lispro per sliding scale for type 2 diabetes mellitus; oxycodone controlled release (60 mg TID) for chronic osteoarthritis and low back pain; alprazolam (0.5 mg every 8 hours as needed) for generalized anxiety disorder; venlafaxine (150 mg BID) for depression; and gabapentin (300 mg TID) for diabetic peripheral neuropathy. The patient's symptoms (hearing loss, myoclonus, and confusion) improved after 1 session of hemodialysis (approximately 10 hours following admission) and had resolved at the time of discharge (4 days later). On admission, the gabapentin concentration was 17.6 microg/mL, and following hemodialysis, the gabapentin concentration was undetectable (by discharge/day 4). The timing of the patient's last dose of gabapentin is unknown. Normal doses for the treatment of diabetic peripheral neuropathy range from 900 to 3600 mg/d divided 3 times daily.
We report a patient with acute renal failure who developed hearing loss, myoclonus, and confusion with hallucinations in the presence of elevated gabapentin concentrations. Due to rapid improvement after hemodialysis and discontinuation of gabapentin, we believe that these symptoms were probably due to gabapentin toxicity.
如文献所述，肾功能受损患者的加巴喷丁毒性可表现为昏迷、肌阵挛、震颤或精神状态改变。加巴喷丁是一种抗癫痫药物，被指定用作部分性癫痫发作和带状疱疹后神经痛的辅助治疗，但也被用于治疗糖尿病性周围神经病变。
一名46岁白人女性（身高167厘米；体重177千克；体重指数62.8千克/平方米），有6年糖尿病病史，既往肾功能正常，因无尿（血清肌酐水平7.4毫克/分升）、听力丧失、肌阵挛以及持续3天的伴有幻觉的意识模糊，就诊于维克森林大学浸信会医学中心急诊科。她的血压为110/74毫米汞柱。患者入院前的用药清单包括：用于高血压的赖诺普利（每日40毫克）、氢氯噻嗪（每日25毫克）和呋塞米（每日80毫克）；用于高脂血症的阿托伐他汀（每日10毫克）；用于胃食管反流病的奥美拉唑（每日20毫克）；用于哮喘的沙美特罗/氟替卡松吸入器（100/50微克；每日两次，每次1吸）和沙丁胺醇定量气雾剂（按需90微克）；用于2型糖尿病的二甲双胍（每日两次，每次500毫克）和根据血糖水平调整剂量的赖脯胰岛素；用于慢性骨关节炎和腰痛的羟考酮控释片（每日三次，每次60毫克）；用于广泛性焦虑症的阿普唑仑（按需每8小时0.5毫克）；用于抑郁症的文拉法辛（每日两次，每次150毫克）；以及用于糖尿病性周围神经病变的加巴喷丁（每日三次，每次300毫克）。患者在接受1次血液透析（入院后约10小时）后，其症状（听力丧失、肌阵挛和意识模糊）有所改善，并在出院时（4天后）已消失。入院时加巴喷丁浓度为17.6微克/毫升，血液透析后加巴喷丁浓度未检测到（出院时/第4天）。患者最后一次服用加巴喷丁的时间不详。治疗糖尿病性周围神经病变的正常剂量范围为每日900至3600毫克，分3次服用。
我们报告了一名急性肾衰竭患者，在加巴喷丁浓度升高的情况下出现了听力丧失、肌阵挛和伴有幻觉的意识模糊。由于血液透析和停用加巴喷丁后症状迅速改善，我们认为这些症状可能是由于加巴喷丁毒性所致。
