Pregabalin-Associated Heart Failure Decompensation in a Patient With a History of Stage I Heart Failure

To describe an elderly male patient with a prior history of New York Heart Association (NYHA) class I heart failure (HF) who presented with cardiac decompensation related to pregabalin therapy and to review the literature involving the effects of pregabalin in HF patients.

An 84-year-old man with NYHA class I HF (left-ventricular ejection fraction between 45% and 50%) presented to the emergency department with acute HF decompensation approximately 10 days after initiation of pregabalin for the management of peripheral neuropathy. Discontinuation of pregabalin and administration of furosemide resulted in resolution of symptoms. Shortness of breath; facial, neck, and peripheral edema; and weight gain all improved within 2 days. Three months following discontinuation of furosemide and pregabalin, the patient remained stable without any recurring symptoms or progression in HF.

Pregabalin is associated with a 10% to 15% prevalence of peripheral edema and weight gain, with cases reported in patients both with and without HF. Whereas most reported HF exacerbations have occurred in patients with NYHA class II to IV HF, this case is one of the first to be reported in a patient with NYHA class I. According to the Naranjo probability scale (score of 4), it was possible that the patient's HF symptoms were related to pregabalin. The mechanism of action of pregabalin-induced HF is unknown, but pregabalin has been shown to act as a calcium channel antagonist.

Although further studies are needed, this case suggests that close monitoring of patients with NYHA class I HF should be considered when initiating pregabalin therapy.