Document Detail


Gabapentin toxicity in patients with chronic kidney disease: a preventable cause of morbidity.
MedLine Citation:
PMID:  20362757     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Gabapentin is frequently used as an analgesic in patients with chronic kidney disease. Although gabapentin is well known for its favorable pharmacokinetics, it is exclusively eliminated renally, and patients with chronic kidney disease are at risk for toxicity. Existing literature on such risk is lacking.
METHODS: We examined the Mayo Clinic Rochester database from 1998 to 2007 in patients with serum gabapentin measurements and known medical outcomes. A total of 729 patients were stratified according to their estimated glomerular filtration rate: group I, 126 individuals with estimated glomerular filtration greater than 90 mL/min/1.72 mm(2) [corrected] ; group II, 594 individuals with estimated glomerular filtration less than 90 mL/min/1.72 mm(2) [corrected] without dialysis; group III, 9 individuals with chronic dialysis.
RESULTS: Patients in groups II and III had higher serum gabapentin levels (8.39+/-0.32 microL/mL and 58.8+/-10.22 microL/mL, respectively) than in group I (5.52+/-0.32 microL/mL, P<.01). Toxicity occurred exclusively in groups II (5.56%) and III (77.8%); toxic manifestations were more severe in group III than in group II. Elderly individuals with multiple comorbidities were overrepresented in those with toxic manifestations. Gabapentin toxicity was suspected initially in only 41.5% of symptomatic cases.
CONCLUSION: Gabapentin toxicity in patients with chronic kidney disease is underrecognized. Patients with chronic kidney disease often receive inappropriately high gabapentin dosage for their kidney function, occasioning overt toxicity; advanced age and comorbidity predispose these patients for toxicity. Heightened awareness of such preventable risk, amid the chronic kidney disease epidemic, would be cost-effective and improve healthcare quality.
Authors:
Ladan Zand; Kevin P McKian; Qi Qian
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  123     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-05     Completed Date:  2010-04-22     Revised Date:  2013-06-11    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  367-73     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Distribution
Amines / adverse effects*,  blood,  therapeutic use
Anticonvulsants / adverse effects*,  blood,  therapeutic use
Cyclohexanecarboxylic Acids / adverse effects*,  blood,  therapeutic use
Female
Glomerular Filtration Rate
Humans
Kidney Failure, Chronic / complications*
Male
Middle Aged
Renal Dialysis
Retrospective Studies
gamma-Aminobutyric Acid / adverse effects*,  blood,  therapeutic use
Chemical
Reg. No./Substance:
0/Amines; 0/Anticonvulsants; 0/Cyclohexanecarboxylic Acids; 56-12-2/gamma-Aminobutyric Acid; 6CW7F3G59X/gabapentin
Comments/Corrections
Erratum In:
Am J Med. 2011 Oct;124(10):e9

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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