Ma Li-Ping, Wen Cheng, Zhao Tong-Xiang, Jiang Xiang-Ming, Gu Jin
Office of Clinical Trial Institution, Peking University Shougang Hospital, Beijing 100144, China.
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
World J Clin Cases. 2023 Jun 16;11(17):4060-4064. doi: 10.12998/wjcc.v11.i17.4060.
Pregabalin is widely used to treat neuropathic pain associated with postherpetic neuralgia. To our knowledge, this is the first report on simultaneously occurring dose-related adverse drug reactions (ADRs) of balance disorder, asthenia, peripheral edema, and constipation in an elderly patient after pregabalin.
A 76-year-old female with a history of postherpetic neuralgia was prescribed pregabalin (300 mg daily). After taking pregabalin for 7 d, the patient developed balance disorder, weakness, peripheral pitting edema (2+), and constipation. On days 8-14, the pregabalin dose was reduced to 150 mg/d based on creatinine clearance. The patient's peripheral edema improved significantly with the disappearance of all other adverse symptoms. On day 15, the pregabalin dose was increased to 225 mg/d to relieve pain. Unfortunately, the symptoms mentioned earlier gradually reappeared after 1 wk of pregabalin treatment. However, the complaints were not as severe as when taking 300 mg/d pregabalin. The patient consulted her pharmacist by telephone and was advised to reduce the dose of pregabalin to 150 mg/d and add acetaminophen (0.5 g, q6h) to relieve pain. The patient's ADRs gradually improved over the following week.
Older patients should be prescribed a lower initial dose of pregabalin. The dose should be titrated to the maximum tolerable dose to avoid dose-limiting ADR. Dose reduction and the addition of acetaminophen may help limit ADR and improve pain control.
普瑞巴林广泛用于治疗带状疱疹后神经痛相关的神经性疼痛。据我们所知，这是首例关于老年患者服用普瑞巴林后同时出现剂量相关不良反应（ADR），包括平衡障碍、乏力、外周水肿和便秘的报告。
一名76岁女性，有带状疱疹后神经痛病史，被处方普瑞巴林（每日300mg）。服用普瑞巴林7天后，患者出现平衡障碍、虚弱、外周凹陷性水肿（2+）和便秘。在第8至14天，根据肌酐清除率将普瑞巴林剂量减至150mg/d。患者的外周水肿明显改善，所有其他不良症状消失。在第15天，将普瑞巴林剂量增至225mg/d以缓解疼痛。不幸的是，在普瑞巴林治疗1周后，上述症状逐渐再次出现。然而，症状不如服用300mg/d普瑞巴林时严重。患者通过电话咨询了药剂师，建议将普瑞巴林剂量减至150mg/d，并加用对乙酰氨基酚（0.5g，每6小时一次）以缓解疼痛。在接下来的一周里，患者的ADR逐渐改善。
老年患者应给予较低初始剂量的普瑞巴林。剂量应滴定至最大耐受剂量，以避免出现剂量限制性ADR。减少剂量并加用对乙酰氨基酚可能有助于限制ADR并改善疼痛控制。
