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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 105-107

Peripheral edema associated with low dose of pregabalin in an older person


M.D. Psychiatry, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission05-Jul-2020
Date of Decision05-Sep-2020
Date of Acceptance19-Sep-2020
Date of Web Publication21-Jan-2021

Correspondence Address:
Dr. Aseem Mehra
Department of Psychiatry, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Cobalt Block, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jgmh.jgmh_31_20

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  Abstract 


Peripheral edema has been reported as an adverse effect of various medications including antibiotics, nonsteroidal anti-inflammatory drugs, anti-hypertensive drugs, antipsychotics, etc., There are a limited number of cases reported the association of a high dose of Pregabalin association with peripheral edema, but none of them reported the low dose association with peripheral edema. We report a case of an older person presented with depressive disorder, had peripheral edema with 50 mg of pregabalin. It is suggested that a clinician should be aware of this association. Geriatrician should be careful when advising the pregabalin to an older person.

Keywords: Adverse effect, peripheral oedema, pregabalin


How to cite this article:
Kumari S, Mehra A, Grover S. Peripheral edema associated with low dose of pregabalin in an older person. J Geriatr Ment Health 2020;7:105-7

How to cite this URL:
Kumari S, Mehra A, Grover S. Peripheral edema associated with low dose of pregabalin in an older person. J Geriatr Ment Health [serial online] 2020 [cited 2021 Jun 25];7:105-7. Available from: https://www.jgmh.org/text.asp?2020/7/2/105/307589




  Introduction Top


Pregabalin is one of the medications used for neuropathic pain,[1] and it is also efficacious in reducing the severity of symptoms of anxiety, sleep disturbances, and depressive symptoms.[2] In patients with psychiatric illness, Pregabalin is used either as adjunctive or second-line treatment.[2] The most common side effects associated with pregabalin are dizziness, dry mouth, somnolence, and ataxia. Peripheral edema is one of the rarest reported side effects and reported to occur in up to 8' of treated patients in clinical trials.[3] The peripheral edema is a dose-related side effect and usually associated with high dose, i.e., up to 600 mg/day. In one case report, peripheral edema reported at a medium dose of 150 mg/day is.[3],[4] To date, no case of peripheral edema has been reported at a low dose of 50 mg of pregabalin. From a psychiatric point of view to the best of knowledge, only two cases of peripheral edema are reported in young females suffering from anxiety disorders.[5],[6]

In the index, we are reporting a case of 57-year-old female presenting with depressive disorder developed peripheral edema with a very low dose of pregabalin of 50 mg/day. Peripheral edema at a dose of 50 mg in an older person has never been reported in the existing literature.


  Case Report Top


A 55-year-old female presented to psychiatry outpatient clinic with symptoms of low mood, decreased energy, easy fatigability, decreased sleep and appetite, decreased self-esteem, decreased attention and concentration, and idea of hopelessness and worthlessness with the idea of reference and persecution. She was diagnosed with severe depressive disorder with psychotic symptoms. On further exploration, it was found that 2½ years back had a similar set of symptoms and treated with Cap. Venlafaxine 150 mg/day and Tablet Olanzapine 5 mg/hs. She recovered within 2 months and stopped medication after a period of 1½ years. She was diagnosed with carcinoma of the breast, 1 year back and received treatment (chemotherapy and radiotherapy) for the same, currently was off medication for the last 6 months. She was also a known case of hypertension and hypothyroidism, taking tablet telmisartan 40 mg and tablet thyroxine 50 mg for the last 4–5 years and were under controlled. Her investigation, including complete blood count, sodium, potassium, liver function test, renal function test, Vitamin B12, Vitamin D and electrocardiogram were within the normal limits. Considering, good response with Venlafaxine and Olanzapine in the past started on the same medications along with clonazepam up to 0.75 mg/day. Gradually, she showed some improvement with these medications; hence clonazepam was stopped.

For the last 10–15 days, started complaining of generalized diffuse pain, numbness in hands and feet. For which initially, Cap Venlafaxine was increased to 187.5 mg/day but had no relief. Following which tablet Preagablin 50 mg hs was added because of pain and numbness in fingers and toes. After the start of pregabalin, on the 2nd day, she developed peripheral edema, more pronounced in the feet, as shown in [Figure 1]. She stopped moving out of the bed, complained of heaviness and pain in the lower limb along with heightened anxiety. Tablet pregabalin was discontinued and investigated thoroughly. The investigation, including the complete blood count, blood urea, creatinine, sodium, potassium, renal parameters, thyroid function test, fasting blood glucose, erythrocyte sedimentation rate and C-reactive protein were found to be within the normal range. After the stoppage of the Pregabalin, the peripheral edema resolved significantly within 2 days, as shown in [Figure 2]. On Naranjo scale, scored a score of 6, suggests that peripheral edema probably occurred due to pregabalin.
Figure 1: Representing oedema after taking of pregabalin

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Figure 2: After complete resolution of oedema

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  Discussion Top


Peripheral edema has been associated with medications such as steroids, immune modulator, cyclosporin, lithium, calcium channel blockers, Nonsteroid inflammatory drugs.[7],[8] The hypnotics, Zopiclone can cause angioedema in a rare case.[8] The experience of peripheral Oedema with Pregabalin is one of the rarest incidences reported in the existing literature. The proposed mechanism for pregabalin as given by the Wustmann et al., 2009[5] that through K+ channels in smooth muscle cells. However, the exact mechanism is still unclear. The previous cases reported the development of peripheral edema with pregabalin,[5],[6] similar to our index patient. However, in the earlier cases, peripheral edema developed after 2 weeks to 10 months.[3],[5],[6],[9] In the present case, developed within 2 days, no reason or explanation for this, but futuristic studies may help.

Pregabalin is indicated for neuropathic pain, bipolar disorder, migraine, and anxiety; however the off-label use of medication for symptoms like sleep disturbances, somatic symptoms, adjunct treatment for depression, etc., continuously growing.[1],[10] As a clinician, we should be aware of the side effects of pregabalin like peripheral edema, as occurred in the present case. The early identification of the symptoms is essential, neither it can worsen the existing physical illness, prolonged stay in hospital or frequent hospitalization, increased morbidity, and undue financial burden of investigation. Second, a low dose of pregabalin can cause peripheral edema as in the present case-patient developed peripheral edema at a dose of 50 mg/day. In contrast to previous findings that edema is associated with the titration of the dose. It can be understood as many of times the edema is mild, self-resolving and for a temporary period, which is difficult to identify.

It can be concluded that a low dose of pregabalin can cause peripheral edema. As a geriatric clinician, there is a need to take special care when prescribing the pregabalin to the older person. Further research in this area will be of interest.

Informed patient consent

The consent was obtained from the patient to report the findings.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zaccara G, Gangemi P, Perucca P, Specchio L. The adverse event profile of pregabalin: A systematic review and meta-analysis of randomized controlled trials. Epilepsia 2011;52:826-36.  Back to cited text no. 1
    
2.
Bandelow B, Zohar J, Hollander E, Kasper S, Möller HJ; WFSBP Task Force on Treatment Guidelines for Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disoders, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders-first revision. World J Biol Psychiatry 2008;9:248-312.  Back to cited text no. 2
    
3.
Semel D, Murphy TK, Zlateva G, Cheung R, Emir B. Evaluation of the safety and efficacy of pregabalin in older patients with neuropathic pain: Results from a pooled analysis of 11 clinical studies. BMC Fam Pract 2010;11:85.  Back to cited text no. 3
    
4.
New Warnings For Peripheral Edema for Combination of Pregabalin (Lyrica) Plus Glitazones. Available from: http://www.diabetesincontrol.com/new-warnings-for-peripheral-edema-for-combination-of-pregabalin-lyrica-plus-glitazones. [Last accessed on 2020? Sep 05].  Back to cited text no. 4
    
5.
Wustmann T, Piro J, Gutmann P. Metabolic considerations in a case of pregabalin-induced edema. Pharmacopsychiatry 2009;42:75-6.  Back to cited text no. 5
    
6.
Krüger S, Lindstaedt M. Pregabalin and edema in young women suffering from premenstrual syndrome. Pharmacopsychiatry 2010;43:202-3.  Back to cited text no. 6
    
7.
Schroth BE. Evaluation and management of peripheral edema. JAAPA 2005;18:29-34.  Back to cited text no. 7
    
8.
Muller-Oerlinghausen B, Greil W, Berghofer A. Die Lithiumtherapie: Nutzen, Risiken, Alternativen.2nd ed. Springer, Verlag Berlin, Heidelberg; 1997.  Back to cited text no. 8
    
9.
Guzelkucuk U, Duman I, Yilmaz B, Tan AK. Reversible post-pregabalin peripheral edema in a spinal cord injury patient. Spinal Cord 2012;50:472-3.  Back to cited text no. 9
    
10.
U.S. Food and Drug Administration. Joint Meeting of the Peripheral and Central Nervous Drugs Advisory Committee and the Psychopharmacologic Drugs Advisory Committee: Briefing Material; 10 July, 2008.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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