To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links). |
Clinical features |
Isolated gabapentinoid (gabapentin, pregabalin) overdoses typically cause only mild somnolence, dizziness, and/or ataxia. Vital signs are typically in a normal range. |
Less common clinical findings can include:
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Toxicity can develop from therapeutic dosing in chronic kidney disease given primarily renal elimination. |
Co-ingestion with other substances (eg, opioids) is common. |
Long-term gabapentinoid therapy can lead to the development of tolerance, dependence, and withdrawal symptoms with cessation of therapy. |
Diagnostic evaluation |
All symptomatic patients |
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Treatment |
Supportive care |
CNS depression – Most patients with isolated gabapentinoid poisoning recover uneventfully with supportive care without specific intervention. Tracheal intubation may be required if the patient is unable to protect their airway. |
Decreased respiratory rate and somnolent – Adults and adolescents: naloxone 0.2 to 2 mg IV/IM or 4 mg IN (children <5 years or ≤20 kg: 0.1 mg/kg/dose IV/IM [maximum dose 2 mg] or 4 mg IN; children ≥5 years or >20 kg: 2 mg IV/IM or 4 mg IN). Naloxone would not be expected to reverse the effects of the gabapentinoid itself but may improve mental status or respiration if the patient has concomitant opioid intoxication, which are common co-ingestants. |
Tachycardia and/or hypotension (uncommon) – IV isotonic saline or lactated Ringer (10 to 20 mL/kg, maximum dose 1 L) boluses. |
Seizures (for dosing, timing, and alternative medications for refractory seizures, refer to UpToDate content on convulsive status epilepticus) – Antiseizure medications are typically not needed since most seizures are self-limited and brief. For recurrent or prolonged seizures, benzodiazepines are first-line therapy: eg, lorazepam 4 mg IV (children: 0.1 mg/kg IV, maximum dose 4 mg). |
Routine gastrointestinal decontamination with activated charcoal for isolated gabapentinoid ingestion is typically not needed since intoxication will improve with supportive care. |
Extracorporeal removal |
Hemodialysis effectively clears gabapentin and pregabalin and shortens duration of toxicity. It should be performed in a patient with severe gabapentinoid poisoning (eg, coma or respiratory failure with need for mechanical ventilation) and severe kidney impairment (refer to UpToDate content for specific criteria). |
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