Pregabalin and Renal Function – Case Study

In this case scenario, I discuss the relationship between pregabalin and renal function.

JE is a 69-year-old male who has a history of diabetes, hypertension, neuropathy, back pain, hyperlipidemia, BPH, anxiety, GERD, and mild cognitive impairment.

His current medications include:

Lyrica (pregabalin) 150 mg twice daily for neuropathic pain
Lisinopril 20 mg once daily for hypertension
Metformin 500 mg twice daily for type 2 diabetes
Atorvastatin 40 mg once daily for hyperlipidemia
Aspirin 81 mg once daily for cardiovascular prevention
Acetaminophen 500 mg as needed for pain
Omeprazole 20 mg once daily for gastroesophageal reflux disease (GERD)
Amlodipine 5 mg once daily for hypertension
Tamsulosin 0.4 mg once daily for benign prostatic hyperplasia (BPH)
Alprazolam 0.25 mg as needed for anxiety (infrequent use)

Upon presentation today, he and his wife reported that he seems more confused than normal and very lethargic. They report that they have not been using the alprazolam recently.

Labs today reveal a creatinine of 1.76 while the previous level a year ago was 1.1.

Pregabalin and Renal Function – Discussion

It appears that renal function has declined significantly. This decline would likely lead to an increase in the drug concentrations of pregabalin as this medication is primarily eliminated by the kidney. Metformin is also of concern here but the clinical symptoms are more likely adverse effects of pregabalin versus metformin (good board exam question).

At a minimum, I would recommend reducing the pregabalin to 75 mg twice daily and if I felt symptoms were severe, you could make the argument to ultimately discontinue this medication. Further work up and evaluation of what may have caused the rise in creatinine would be an important part of the assessment as well but the new symptoms are likely from the accumulation of pregabalin.

The scenario of pregabalin and renal function outlines the importance of monitoring renal function and why we dose adjust medications based upon how well the kidney is working. It is important to recognize which commonly used medications can accumulate when renal function declines as well as the common adverse effect profile of each medication.

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