GÜLAY ERDOĞAN KAYHAN, Dilek CEYHAN, MEHMET SACİT GÜLEÇ

Possible heart failure associated with pregabalin use-Case report

Pregabalin ve gabapentin, göreceli güvenilirlikleri ve kolay tolere edilebilmeleri nedeniyle kullanım alanı giderek genişleyen antikonvülzan, analjezik ve anksiyolitik ajanlardır. Buna karşı; baş dönmesi, somnolans, doz bağımlı periferik ödem ve kilo artışı gibi yan etkileri ilaç kesilmesine neden olabilmektedir. Ayrıca, literatürde ciddi kronik hastalık öyküsü ve kardiyak öyküsü olan yaşlı hastalarda kalp yetmezliği geliştiğine dair az sayıda olguya rastlanmıştır. Bu olguda, kardiyak öyküsü olmayan ve nöropatik ağrı nedeniyle 300mg/gün pregabalin sonrası öncelikle periferik ödem ve sonrasında ileri tetkiklerde tespit edilen santral ödem tablosu gelişen bir hasta sunulmaktadır. Pregabalin kesilmesi sonrası tablonun gerilediği gözlenmekle birlikte önerilen dozlarda başlanan gabapentinle de periferik ödem gelişmiştir. New York Kalp Cemiyeti sınıf III-IV kalp yetmezliği olan hastalarda pregabalin reçete edilirken dikkatli olunması konusunda uyarmıştır. Etki mekanizmaları henüz netlik kazanmamış olmakla birlikte kalsiyum kanalları üzerindeki etkileri bu yan etkilerle ilişkili olabilir. Sonuç olarak, giderek artan hızda kullanılan bu ilaçların yan etkiler açısından ileri kardiyak hastalar dışında da yakından takip edilmesi gerektiği kanaatindeyiz.

Pregabalin kullanımı sonrası gelişen muhtemel kalp yetmezliği-Olgu sunumu

Pregabalin and gabapentin are widely used analgesic, anticonvulsant and anxiolytic agents as they are relatively reliable and easily tolerable. However, use of them may cause some side effects such as dizziness, somnolance, dose dependent peripheral edema and weight gain which may cause to give up the use of them. Besides, there are few reports in literature addressing old aged patients with serious chronic disease and cardiac history, develope heart failure during pregabaline application. In this case, we present a patient, without a cardiac history, treated with 300 mg/kg pregabalin due to neuropatic pain, developed peripheral and then central edema which were determined after advanced investigations. After quitting pregabalin the situation regressed. Then, peripheral edema has developed associated with recommended dose of gabapentin use instead of pregabalin. Despite the presence of any published evidence, New York Heart Association issued a warning about being careful when prescribing pregabalin to type III-IV heart failure patients. Though the effect mechanisms of pregabalin and gabapentin are not well known, calcium channel relationship may led to these side effects. In summary, we believe that pregabalin and gabapentin, which is mostly used nowadays, should be administered with care not only in patients with advanced cardiac pathology but also in all patients due to its potential side effects.

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