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Flumazenil and dialysis for gabapentin-induced coma
Toni C Butler1, Raquel M Rosen, Allison L Wallace
1Department of Surgery, Bassett Healthcare, Cooperstown, NY 13326-1394, USA.
The Annals of Pharmacotherapy
|December 31, 2002
Summary
Gabapentin can cause coma in dialysis patients, but flumazenil and hemodialysis can reverse it. This case highlights the importance of cautious gabapentin dosing in this population.
Area of Science:
- Pharmacology
- Nephrology
- Toxicology
Background:
- Gabapentin is a commonly prescribed anticonvulsant and analgesic.
- Patients with end-stage renal disease requiring dialysis are at increased risk for gabapentin toxicity due to impaired drug clearance.
- Coma is a rare but serious adverse effect of gabapentin overdose or accumulation.
Observation:
- An 83-year-old dialysis-dependent male presented with coma after a single dose of gabapentin for phantom limb pain.
- The patient regained consciousness following administration of flumazenil.
- Subsequent hemodialysis effectively reduced serum gabapentin concentrations.
Findings:
- Flumazenil demonstrated efficacy in reversing gabapentin-induced coma.
- Hemodialysis was effective in clearing gabapentin from the serum, as evidenced by pre- and post-dialysis concentration monitoring.
- Causality assessment indicated a probable relationship between gabapentin and the adverse event.
Implications:
- This case suggests flumazenil as a potential antidote for gabapentin-induced coma.
- It emphasizes the critical need for dose adjustment of gabapentin in dialysis-dependent patients.
- This report provides valuable insights into managing gabapentin toxicity in renally impaired individuals.