Delirium secondary to pregabalin

Hickey, Catherine; Thomas, Barbara

doi:10.1016/j.genhosppsych.2011.11.004

Cited by 11 publications

(17 citation statements)

References 10 publications

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“…It should be noted that even a low dose of pregabalin can cause delirium; previous studies have found that administration of 75 or 150 mg of pregabalin for 3-7 days caused hyperactive delirium in 45-and 65-year-old female patients. 7,8 In fact, a dose of just 100 mg of pregabalin caused delirium in the present patient.…”

Section: Discussionmentioning

confidence: 53%

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Patient with insidious hypoactive delirium associated with pregabalin

Mezaki

Ishihara

Ozawa

et al. 2013

Neurology & Clinical Neurosc

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Pregabalin has favorable effects on several types of neurological pain, but can cause side-effects including dizziness, somnolence and delirium. Delirium presents as two variants in terms of psychomotor disturbance: the hyperactive type, showing agitation and vigilance; and the hypoactive type, showing lethargy and decreased motor activity. Patients with delirium associated with pregabalin therapy have been reported to experience hyperactive delirium. Here, we report the case of a 68-year-old patient with insidious hypoactive delirium caused by pregabalin therapy for postherpetic neuralgia. Delirium improved after discontinuation of pregabalin. Hypoactive delirium is considered to be more common than the hyperactive type in older adults, and is likely to be overlooked. Attention should thus be paid to latent cases of hypoactive delirium associated with pregabalin therapy in elderly individuals.Delirium is an acute state of confusion and is common among elderly individuals.1,2 Delirium has two variants in terms of psychomotor disturbance: the hyperactive type, associated with agitation and vigilance; and the hypoactive type, showing lethargy and decreased motor activity, and individuals often experience switching between variants. [1][2][3] Pregabalin is an analog of gabapentin, and binds to the a 2 -d protein subunit of voltage-gated calcium channels, and not to gamma amino butyric acid receptor, in the central nervous system. 4 Pregabalin is effective in the treatment of neuropathic pain associated with diabetic neuropathy, fibromyalgia and postherpetic neuralgia. [4][5][6] We report the case of a patient who developed insidious hypoactive delirium induced by pregabalin therapy. Case reportThe patient was a 68-year-old man who had been treated in March 2007 for dementia and anorexia. He was subsequently diagnosed with panhypopituitarism caused by pituitary sarcoidosis. Symptoms improved after initiating treatment with prednisolone and levothyroxine in September 2007. He developed herpes zoster on the left neck and shoulder in September 2010, and 25 mg of pregabalin had been administered for postherpetic neuralgia since August 2011. His wife reported that he was free from any signs of cognitive function decline or appetite loss before the initiation of pregabalin therapy. The dose of pregabalin was initially increased by 25 mg every 2 weeks, and had been maintained at 100 mg since September 2011. Around that time, he felt lethargic, and motor activity, attentiveness and cognitive function showed rapid disruption. He suffered from these symptoms for 3 months, before being admitted to Niigata University Medical & Dental Hospital, Niigata, Japan, in February 2012.On admission, he showed lethargy, hallucinations and decreased motor activity. He did not have a sense of insecurity or other complaint related to depression. The results of blood testing, including testing of thyroid function, cerebrospinal fluid analysis and levels of various autoantibodies, were all normal on admission. Neurological examination ...

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Section: Discussionmentioning

confidence: 53%

“…Only a few cases of delirium caused by pregabalin have been reported, and all involved hyperactive delirium. 7,8 Hyperactive delirium is easily identified because of the prominent agitation and vigilance. However, hypoactive delirium is difficult to diagnose, and is often overlooked.…”

Section: Discussionmentioning

confidence: 99%

Patient with insidious hypoactive delirium associated with pregabalin

Mezaki

Ishihara

Ozawa

et al. 2013

Neurology & Clinical Neurosc

View full text Add to dashboard Cite

show abstract

“…In general, the emergence of acute confusional state or delirium in healthy young people leads to extensive diagnostic investigation for potentially serious illnesses, such as encephalitis, metabolic disorders and infections, however the side effects of drugs should also be considered. Only few reports have described acute confusion state during Pregabalin use 3 . Also, psychosis has already been described in one patient, but this is a rare condition Hence, neurologists have prescribed Pregabalin more often in daily medical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Transient post-ictal hyperthermia may follow generalized convulsive status epilepticus 2,3 . In our case, over four years of follow-up, the patient presented three episodes of right focal motor seizures with consciousness impairment and a prolonged post-critic with aphasia, right homonymous hemianopsia, right hemiparesis, and hyperthermia.…”

Section: Discussionmentioning

confidence: 99%

“…It seems possible that the thermoregulatory center in the hypothalamic pre-optic area may be affected by spreading epileptic activity, and thus cause elevated body temperature [3][4][5] . The mesial temporal lobe structures have extensive connections with the neuroendocrine hypothalamus portion, and a discharging temporal focus can possibly alter hypothalamic function 3 . Another mechanism may involve vagal nerve nuclei (nucleus tractus solitarius) modulation during seizures 2 .…”

Section: Discussionmentioning

confidence: 99%

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