Pregabalin and paradoxical reaction of seizures in a large overdose

Abstract

ABSTRACTWe report the case of a 54-year-old female with intentional pregabalin 3825 mg ingestion that resulted in a rare adverse effect of a witnessed seizure with confirmatory serum concentrations. After presenting alert to the emergency department she became obtunded, only responding to sternal rub (four hours after ingestion). Laboratory evaluation and toxicology panel were unremarkable. Approximately eight hours after the ingestion she had physician-witnessed tonic–clonic seizure activity with right gaze deviation for 90 seconds. This is only the third documented case of paradoxical seizure due to a large overdose of pregabalin. Also, the serum concentration observed is among the highest recorded (58 mcg/mL five hours post-ingestion). Pregabalin abuse has been emerging. Clinical toxicologists should be aware of the potential of pregabalin-induced seizures following overdose.