Treatment of Gabapentin Toxicity With Peritoneal Dialysis: Assessment of Gabapentin Clearance

Ibrahim, Hisham; Oman, Zachary; Schuelke, Matthew J.; Edwards, John C.

doi:10.1053/j.ajkd.2017.05.010

Cited by 12 publications

(6 citation statements)

References 11 publications

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“…Evidence suggests that carbamazepine may be as effective as gabapentin for treating neuropathic pain in the general population and may have fewer adverse effects. Unlike gabapentin, it requires no dose adjustment in CKD as outlined in Table 6 (31). Tricyclic antidepressants are effective in the management of neuropathic pain but are less well tolerated than the gabapentinoids in patients with CKD because of anticholinergic, histaminergic, and adrenergic side effects resulting in symptoms such as dry mouth, orthostatic hypotension, and somnolence.…”

Section: Putting It All Together: a General Approach To The Pharmacolmentioning

confidence: 99%

Clinical Pharmacology Considerations in Pain Management in Patients with Advanced Kidney Failure

Davison¹

2019

CJASN

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Pain is common and poorly managed in patients with advanced CKD, likely due to both under and over prescription of appropriate analgesics. Poorly managed pain contributes to patients' poor quality of life and excessive health care use. There is tremendous variability within and between countries in prescribing patterns of analgesics, suggesting that factors other than patient characteristics account for these differences. This article discusses the pharmacologic management of acute and chronic pain in patients with advanced CKD, and the role analgesics, including opioids, play in the overall approach to pain management.

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Section: Putting It All Together: a General Approach To The Pharmacolmentioning

confidence: 99%

Clinical Pharmacology Considerations in Pain Management in Patients with Advanced Kidney Failure

Davison¹

2019

CJASN

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“…Intensive PD can be used to treat gabapentin toxicity, provided the patient is stable; however, in case of emergency, HD will provide much more rapid removal of gabapentin. To avoid toxicity, it would be prudent to monitor gabapentin concentrations in dialysis patients, particularly after changes to dialysis prescription have been inducted (13).…”

Section: Discussionmentioning

confidence: 99%

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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“…Previous reports have suggested gabapentininduced hypoglycemia. [2][3][4] Gabapentin was started less than 1 week prior to the level 3 hypoglycemia. After reviewing the case, no alternatives could be identified as a potential cause of hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

“…Although case reports suggest that gabapentin is effectively cleared by peritoneal dialysis, one cannot discount it as a contributing factor. 3 The other publication is a retrospective database case series of 6 patients in the Netherlands. 4 Dosing of gabapentin ranged from 300 to 1800 mg daily.…”

Section: Introductionmentioning

confidence: 99%

Patient Case Report: Gabapentin-Induced Hypoglycemia

Hayes

Ferdinand

Neabore³

et al. 2020

Journal of Pharmacy Practice

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Purpose: Gabapentin is an analog of gamma-aminobutyric acid (GABA), but its complete mechanism is not well understood. Common adverse effects from gabapentin include somnolence, sedation, and dizziness. Hyperglycemia is listed as a possible adverse drug reaction in the labeling. Case reports describe hypoglycemia in patients with diabetes, peritoneal dialysis, and/or incomplete medication records. The following case report details a hypoglycemia episode as a potential result of a gabapentin use in a patient without diabetes. Summary: A 47-year old, 68 kg, white female presented to the emergency department with altered mental status. Her blood glucose level was 33 mg/dL. Gabapentin was started 1 week prior to the hypoglycemia episode. Her past medical history, concomitant medications, and other laboratory findings were not likely causes of her severe hypoglycemia. Conclusion: Gabapentin appears to have effects on several voltage-gated calcium channels. Hypoglycemia may be due to gabapentin binding to the alpha2delta subunit of the calcium channels in the pancreas. Future research should investigate gabapentin and the potential for hypoglycemia.

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Treatment of Gabapentin Toxicity With Peritoneal Dialysis: Assessment of Gabapentin Clearance

Cited by 12 publications

References 11 publications

Clinical Pharmacology Considerations in Pain Management in Patients with Advanced Kidney Failure

Clinical Pharmacology Considerations in Pain Management in Patients with Advanced Kidney Failure

Gabapentin Toxicity and Role of Dialysis

Patient Case Report: Gabapentin-Induced Hypoglycemia

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