High-flow continuous hemodiafiltration successfully decreased blood pregabalin levels in a patient with severe pregabalin intoxication: a case report

Background Severe pregabalin intoxication may cause serious symptoms, such as coma. Since pregabalin is a small molecule with no protein binding sites and has low volume of distribution, hemodialysis can be effective in eliminating pregabalin from the blood. However, in cases of emergency, it is not always possible to perform hemodialysis because of limited availability and time delay associated with using the plumbing equipment. Continuous hemodiafiltration (CHDF) can be performed without plumbing equipment; however, the knowledge on the effectiveness of CHDF in pregabalin elimination is insufficient. Case presentation A septuagenarian woman with normal renal function was found in a collapsed state with symptoms of coma and miosis. Empty medical bags of pregabalin (2350 mg), bepotastine besilate (600 mg), celecoxib (4600 mg), quetiapine fumarate (87.5 mg), clotiazepam (180 mg), and teprenone (50 mg) were found around her. During the patient's transfer to our hospital, her cognition worsened and she developed glossoptosis necessitating her emergent intubation upon arrival. We considered that the coma was mainly caused by pregabalin intoxication and were concerned about the consequent critical comorbidities. Thus, we performed CHDF in a high-flow setting in our intensive care unit for pregabalin elimination. After 8 h of CHDF, the patient regained consciousness, and after 6.5 h we extubated her. At a later date, we measured her serum pregabalin levels during the clinical course and estimated the blood pregabalin clearance levels depending on her metabolism as 76.8 mL/min and depending on CHDF itself as 65.1 mL/min. Based on these findings, we concluded that CHDF contributed to reducing blood pregabalin levels in this patient. Conclusions Our case revealed that pregabalin clearance using CHDF is similar to metabolic clearance in patients with normal renal function, indicating that CHDF decreases blood pregabalin levels and can be a potential treatment for severe pregabalin intoxication.