A case of gabapentin overdose induced rhabdomyolysis requiring renal replacement therapy

Qiu, Xiaoliang; Tackett, Eva; Khitan, Zeid

doi:10.1002/ccr3.2302

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…We identified 26 case reports of rhabdomyolysis induced by newer-generation ASMs, with 26 patients included (10 males and 16 females) ( Kaufman and Choy, 2012 ; Gunathilake et al, 2013 ; Akiyama et al, 2014 ; Isaacson et al, 2014 ; Spengler et al, 2014 ; Incecik et al, 2016 ; Karaoulanis et al, 2016 ; Kato et al, 2016 ; Ramon et al, 2016 ; Singh et al, 2016 ; Choi et al, 2017 ; Coupal et al, 2017 ; Di Lorenzo and Li, 2017 ; Kubota et al, 2017 ; Shahbaz et al, 2017 ; Matsudaira et al, 2018 ; Mena-Martin et al, 2018 ; Rastogi et al, 2018 ; Rota et al, 2018 ; Qiu et al, 2019 ; Thomas et al, 2019 ; Aslan et al, 2020 ; Ghosh et al, 2020 ; Moinuddin, 2020 ; Alshehabi et al, 2022 ; Boucher et al, 2022 ) ( Table 3 ). All the studies were published in English and originated from the following regions: 10 cases from South America, 10 cases from Asia, 5 cases from Europe and 1 case from Oceania.…”

Section: Resultsmentioning

confidence: 99%

“…Rhabdomyolysis is known to be a common adverse effect of statins. Of the three patients who took Frontiers in Pharmacology frontiersin.org statins as concomitant therapy, two patients took statins for a longer period (Gunathilake et al, 2013;Qiu et al, 2019), and one patient developed myalgia symptoms after 4 days of statin and increased dose of gabapentin for 1 day. In this case, both statins and gabapentin may have been responsible for his rhabdomyolysis (Kaufman and Choy, 2012).…”

Section: Discussionmentioning

confidence: 99%

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Rhabdomyolysis associated with newer-generation anti-seizure medications (ASMs): a real-world retrospective and pharmacovigilance study

Deng,

Wang,

2023

Front. Pharmacol.

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Objective: Rhabdomyolysis is a potentially fatal adverse reaction mostly triggered by certain medications. Few real-world studies have shown a clear association between newer-generation anti-seizure medications (ASMs) and rhabdomyolysis. We sought to quantify the risk and evaluate the clinical features and management of rhabdomyolysis associated with newer-generation ASMs.Methods: Data were retrieved from the US FDA Adverse Event Reporting System database (FAERS) from 2018 to 2022 on newer-generation ASMs to identify rhabdomyolysis events, and disproportionality analyses were conducted by estimating the reporting odds ratios (RORs) and corresponding 95% confidence intervals (CIs). Furthermore, case reports from 2012 to 31 December 2022 on newer-generation ASMs-induced rhabdomyolysis were retrieved for retrospective analysis.Results: A total of 1,130 rhabdomyolysis reports from the FAERS database were considered. Levetiracetam had the greatest proportion and the highest positive signal values of rhabdomyolysis. The RORs (95% CIs) for newer-generation ASMs were, in descending order, levetiracetam 8.01 (7.26–8.84), lamotrigine 3.78 (3.25–4.40), oxcarbazepine 3.47 (2.53–4.75), pregabalin 2.75 (2.43–3.12), lacosamide 1.85 (1.29–2.65), topiramate 1.64 (1.25–2.15), and gabapentin 1.32 (1.13–1.55). Twenty-six case reports showed evidence of rhabdomyolysis, and levetiracetam (65.4%) was the most frequently reported agent. The median age was 32 years; typical initial symptoms included muscle weakness (34.8%), myalgia (34.8%), backache (17.4%), fatigue (13.0%) and leg pain (8.7%). The median time to onset of rhabdomyolysis was 2 days. All cases had elevated creatine phosphokinase (CPK), and some cases were accompanied by elevated creatinine (57.1%) and myoglobinuria (53.8%). Cessation of ASMs could lead to complete clinical remission. The median time for creatine phosphokinase (CPK) normalization was 8 days.Conclusion: This study identified 7 newer-generation ASMs with significant rhabdomyolysis reporting associations. Prescribers should be more aware of this risk and teach patients to recognize rhabdomyolysis signs/symptoms early.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis associated with newer-generation anti-seizure medications (ASMs): a real-world retrospective and pharmacovigilance study

Deng,

Wang,

2023

Front. Pharmacol.

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“…In cases reported with gabapentin toxicity, patients had varying manifestations including tremors, altered mental status, and respiratory depression requiring intubation (5). Rhabdomyolysis is a very rare adverse effect of gabapentin and has been reported in a case study (6). We report three patients with gabapentin toxicity, which highlight the need of early suspicion and timely intervention.…”

Section: Introductionmentioning

confidence: 81%

Gabapentin Toxicity and Role of Dialysis

Latief

Bhat²,

Wani

et al. 2021

jrenhep

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Gabapentin is frequently used as an analgesic in patients with chronic kidney disease (CKD). It is excreted exclusively through kidney, and therefore impairment in kidney function could lead to gabapentin accumulation and hence toxicity. We present our experience of 3 cases with Gabapentin toxicity who were managed according to the severity of symptoms. Case 1: A 32-year-old male was found lying unconscious after consuming around 12,000 mg of gabapentin and had respiratory depression, rhabdomyolysis, and acute kidney injury (AKI). Patient was man-aged with supportive care and hemodialysis (HD). Case 2: A 64-year-old male CKD Stage 5 (5D) patient with diabetic neuropathy was started on gabapentin 300 mg daily by his primary care physician 1 week back. Patient started to feel sleepy and developed altered sensorium and myoc-lonus. Discontinuation of gabapentin and a session of HD led to dramatic improvement in patient’s status. Case 3: A 70-year-old female diabetic patient with CKD Stage 3 and had diabetic neuropathy. Her neuropathic symptoms had improved with gabapentin 300 mg twice daily, but lately patient was feeling sleepy during the day and was confused. Discontinuation of the drug led to improvement in symptoms. Gabapentin is a rel-atively safe medication, but in certain clinical scenarios, particularly in impaired renal functions, can lead to severe complications. Moreover, it per se can rarely lead to rhabdomyolysis and AKI. Clinical suspicion and timely decontamination are needed, and sometimes dialytic therapy may be needed.

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Multiple drugs

2019

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A case of gabapentin overdose induced rhabdomyolysis requiring renal replacement therapy

Cited by 7 publications

References 17 publications

Rhabdomyolysis associated with newer-generation anti-seizure medications (ASMs): a real-world retrospective and pharmacovigilance study

Rhabdomyolysis associated with newer-generation anti-seizure medications (ASMs): a real-world retrospective and pharmacovigilance study

Gabapentin Toxicity and Role of Dialysis

Multiple drugs

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