|Year : 2019 | Volume
| Issue : 1 | Page : 26-27
Pregabalin misuse in a 75-year-old woman
Avinash De Sousa
Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
|Date of Web Publication||16-Aug-2019|
Dr. Avinash De Sousa
Carmel, 18, St. Francis Road, Off SV Road, Santacruz (West), Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
Pregabalin is a drug that has been used in the management of partial epilepsy, generalized anxiety disorder, neuropathic pain, and fibromyalgia. Recently, it has found usefulness in the management of alcohol withdrawal. The use of pregabalin in the elderly is scarce, and data on the same are not easily available. We report herewith the case of pregabalin misuse in a 75-year-old woman with depression and anxiety.
Keywords: Anxiety, depression, misuse, pregabalin, pregabalin misuse
|How to cite this article:|
De Sousa A. Pregabalin misuse in a 75-year-old woman. J Geriatr Ment Health 2019;6:26-7
| Introduction|| |
Pregabalin is a gamma-aminobutyric acid analog used as an antiepileptic and in the management of anxiety disorders., The drug acts through excitatory neuronal transmission through ligands in voltage-sensitive calcium channels and reduces the release of excitatory neurotransmitters as glutamate and noradrenaline. The drug has found recent favor in the management of peripheral neuropathic pain. The US Food and Drug Administration approved its use for diabetic peripheral neuropathy, neuropathic pain associated with postherpetic neuralgia, fibromyalgia, and in adults with partial epilepsy. There have been anecdotal reports of misuse or abuse of the drug reported in literature.,,, We report herewith a case of pregabalin misuse in a 75-year-old woman diagnosed with anxiety and depression.
| Case Report|| |
A 75-year-old widow was referred to the outpatient clinic of our hospital with a history of depression and panic disorder in the past. She was a known case of depression and had been on escitalopram 20 mg since the past 5 years and was maintained on the same. She suddenly developed anxiety in the form of generalized worry and panic like symptoms; however, no formal panic attack occurred. The patient was known to be anxious by nature and had multiple family-related stressors and death of spouse 10 years back that caused her depression, stress, and anxiety. She had taken pregabalin as per her old case papers and responded well to 150 mg. Keeping the same in mind, she was started on pregabalin 75 mg at night which was increased over a week to 150 mg. The patient reported feeling better, less anxious, more energetic, increased self-confidence, and less sleep. She then on her own increased the dose of pregabalin to 225 mg and then went up to 450 mg/day, i.e., six capsules of 75 mg each. The patient was on this dose for 8 days. The patient claimed this increase in dosage was done by her to get an enhanced effect from the medication, i.e., further relief in anxiety symptoms. There was no clinical evidence of an intention to abuse the drug. This was reported on follow-up by the patient's daughter who noticed that medicine was getting over quickly due to increased consumption. The patient when confronted admitted to the increased use. Her mini-mental status examination scores were 29 indicating a clear absence of dementia.
She reported insomnia with low mood after 450 mg of pregabalin daily for 8 days. She also developed a lack of attention and concentration and increase in her depressive mood (despite being maintained on escitalopram 20 mg). All routine blood tests such as blood counts, liver, kidney, thyroid function tests, and electrolytes were within normal limits. She was diagnosed as major depressive disorder with pregabalin abuse. A timed schedule was arranged to terminate pregabalin use by tapering its dose by 300 mg and reducing by 75 mg every 5 days. She was started on quetiapine 50 mg for sleep which was added to escitalopram, and no benzodiazepines were considered due to her age and tendency of probable abuse. Pregabalin was stopped totally in 2 weeks, and the patient had no withdrawal symptoms with the absence of craving for pregabalin. The anxiety and depression improved markedly at the same time. Drowsiness was reported by the patient which was attributed to quetiapine that was then reduced to 25 mg at night. The patient has been following regularly and doing fine ever since.
| Discussion|| |
We have presented here with a case of a 75-year-old woman with depression and anxiety features that started misusing pregabalin on experiencing its anxiolytic effects. The patient misused pregabalin due to the fact that it reduced the severity of her anxiety. The highest daily dose used was 450 mg and has been reported in earlier case reports published.,,, On presentation, pregabalin was discontinued gradually, and low-dose quetiapine was added to the escitalopram that was part of the ongoing treatment. Pregabalin has been used widely in the treatment of generalized anxiety disorder and also has been shown to help in reducing benzodiazepine withdrawal symptoms. Recent reports indicate that pregabalin may be used in alcohol withdrawal management. There is scarcity of data of pregabalin use in the elderly with anxiety and for geriatric substance abuse. Pregabalin misuse in this manner in the elderly has not been reported previously to the best of our knowledge. A review of anecdotal reports attributed the abuse potential of pregabalin due to its mechanisms of action being in the line of that of benzodiazepines. It has been thought that pregabalin euphoric effect increases the risk of abuse or misuse as seen in our case as well. Pregabalin withdrawal includes tremors, craving, anxiety, irritability, sleeplessness, nausea, headache, and diarrhea. Our patient did not experience the same due to gradual tapering of the dose which is needed in such cases. Clinicians treating geriatric patients with depression and anxiety must be aware of the fact that patients may increase the dosage of medications on their own like seen in our case.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Beydoun A, Uthman BM, Kugler AR, Greiner MJ, Knapp LE, Garofalo EA, et al.
Safety and efficacy of two pregabalin regimens for add-on treatment of partial epilepsy. Neurology 2005;64:475-80.
Tassone DM, Boyce E, Guyer J, Nuzum D. Pregabalin: A novel gamma-aminobutyric acid analogue in the treatment of neuropathic pain, partial-onset seizures, and anxiety disorders. Clin Ther 2007;29:26-48.
Schwan S, Sundström A, Stjernberg E, Hallberg E, Hallberg P. A signal for an abuse liability for pregabalin – Results from the Swedish spontaneous adverse drug reaction reporting system. Eur J Clin Pharmacol 2010;66:947-53.
Dworkin RH, O'Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, et al.
Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain 2007;132:237-51.
Gahr M, Franke B, Freudenmann RW, Kölle MA, Schönfeldt-Lecuona C. Concerns about pregabalin: Further experience with its potential of causing addictive behaviors. J Addict Med 2013;7:147-9.
Gahr M, Freudenmann RW, Kölle MA, Schönfeldt-Lecuona C. Pregabalin and addiction: Lessons from published cases. J Subst Use 2014;19:448-9.
Halaby A, Kassm SA, Naja WJ. Pregabalin dependence: A case report. Curr Drug Saf 2015;10:184-6.
Ashwini S, Amit DR, Ivan NS, Alka PV. Pregabalin dependence with pregabalin induced intentional self-harm behavior: A case report. Indian J Psychiatry 2015;57:110-1.
] [Full text]
Grosshans M, Mutschler J, Hermann D, Klein O, Dressing H, Kiefer F, et al.
Pregabalin abuse, dependence, and withdrawal: A case report. Am J Psychiatry 2010;167:869.
Guglielmo R, Martinotti G, Clerici M, Janiri L. Pregabalin for alcohol dependence: A critical review of the literature. Adv Ther 2012;29:947-57.
Caster O, Edwards IR, Norén GN, Lindquist M. Earlier discovery of pregabalin's dependence potential might have been possible. Eur J Clin Pharmacol 2011;67:319-20.