What if the patient's doctor doesn't think the mental status changes are due to Lyrica (pregabalin)?

When a Doctor Doesn't Attribute Mental Status Changes to Lyrica (Pregabalin)

If your doctor doesn't believe mental status changes are due to Lyrica (pregabalin), you should request a thorough evaluation for other potential causes while still considering medication side effects as a possible contributor.

Understanding Mental Status Changes

Mental status changes can have multiple causes that should be systematically evaluated:

• Medication side effects, including Lyrica (pregabalin), can cause altered mental status, confusion, and cognitive changes 1
• Delirium is a clinical diagnosis with acute onset and fluctuating course of cognitive, behavioral, and/or sensorimotor symptoms that requires thorough investigation 1
• Mental status changes should be considered a diagnosis of exclusion, with multiple potential etiologies that must be ruled out 1

Common Causes of Mental Status Changes

When mental status changes occur, several potential causes should be considered:

• Neurological disorders (35% of cases) 2
• Pharmacological and toxicological causes (23% of cases), including medication side effects 2
• Systemic and organic causes (14.5% of cases) 2
• Infections (9.1% of cases) 2
• Metabolic and endocrine disorders (7.9% of cases) 2
• Psychiatric disorders (3.9% of cases) 2

Lyrica (Pregabalin) and Mental Status Changes

Pregabalin has documented effects on mental status:

• Pregabalin can cause drowsiness, dizziness, and cognitive effects 3
• In cardiac surgery patients, pregabalin has been associated with delirium risk 1
• Pregabalin works by binding to alpha2-delta subunits of voltage-gated calcium channels, affecting neurotransmitter release which can impact neurological function 4

Approach When Your Doctor Disagrees

Step 1: Request Comprehensive Evaluation

• Ask for investigation of potential precipitating factors of altered mental status 1
• Request evaluation for both medication-related and non-medication causes 1
• History and physical examination have 94% sensitivity for identifying medical causes of mental status changes 1

Step 2: Suggest Specific Assessments

• Request standardized cognitive assessment using validated tools 1
• Consider temporary discontinuation of Lyrica as a diagnostic trial 1
• Ask about laboratory testing to rule out metabolic, toxic, or infectious causes 1

Step 3: Document and Monitor

• Keep a detailed log of mental status changes, including timing relative to medication doses 1
• Note any improvement when doses are missed or reduced 1
• Record other symptoms occurring alongside mental status changes 1

Step 4: Seek Second Opinion

• If concerns persist, request referral to a neurologist or psychiatrist 1
• Consider consultation with a clinical pharmacist about medication interactions 1
• Bring documentation of symptoms to specialist appointments 1

Important Considerations

• Medication-induced delirium is often reversible, unlike some other causes 1
• Multiple factors can contribute simultaneously to mental status changes 1
• The elderly are particularly vulnerable to medication-induced cognitive effects 1
• Routine brain imaging may not be necessary unless there are focal neurological signs or first episode of altered mental status 1

When to Seek Emergency Care

Seek immediate medical attention if mental status changes include:

• Severe confusion or inability to recognize familiar people 1
• New focal neurological signs or seizures 1
• Fever or signs of infection 1
• Rapid deterioration in mental status 1

Remember that mental status changes are an important warning signal that requires prompt evaluation and treatment to decrease potential morbidity and mortality 2.