Does a dialysis session for fluid removal without dialysate filtration eliminate Lyrica (pregabalin) from the body?

Dialysis for Fluid Removal Only Does Not Eliminate Lyrica (Pregabalin)

A dialysis session for fluid removal only (ultrafiltration without dialysate filtration) does not significantly eliminate Lyrica (pregabalin) from the body. While pregabalin is highly dialyzable during standard hemodialysis with dialysate, ultrafiltration alone lacks the diffusive clearance mechanism needed to remove this medication.

Pharmacokinetics of Pregabalin and Dialysis Mechanisms

• Pregabalin is primarily eliminated unchanged by the kidneys with a mean elimination half-life of 6.3 hours in patients with normal renal function 1, 2
• Pregabalin has pharmacokinetic properties that make it highly dialyzable during standard hemodialysis:
  • Low molecular weight (159.23 Da)
  • Low volume of distribution (approximately 0.5 L/kg)
  • Minimal protein binding (<2%)
  • Minimal metabolism (>90% excreted unchanged in urine) 1, 3
• During standard hemodialysis with dialysate, pregabalin concentrations are reduced by approximately 50% after a 4-hour session 1

Ultrafiltration vs. Standard Hemodialysis

• Ultrafiltration (fluid removal only) works primarily through hydrostatic pressure to remove excess fluid across a semipermeable membrane 4
• Standard hemodialysis removes solutes through diffusion across concentration gradients between blood and dialysate 4
• Without dialysate exchange, the diffusive clearance mechanism necessary for removing medications like pregabalin is absent 4
• Isolated ultrafiltration sessions are sometimes added to standard treatment regimens specifically for fluid management, not for solute removal 4

Clinical Implications

• Patients receiving pregabalin who undergo fluid-only removal sessions will maintain therapeutic (or potentially toxic) levels of the medication 5, 3
• For patients with renal impairment requiring pregabalin:
  • Dose adjustments are necessary based on creatinine clearance 1, 5
  • Supplemental doses may be required after standard hemodialysis sessions (with dialysate) to maintain therapeutic levels 1, 5
• In cases of pregabalin toxicity, standard hemodialysis (not isolated ultrafiltration) has been shown effective for drug removal with clearance rates of approximately 88.8 mL/min 3

Common Pitfalls and Considerations

• Don't confuse ultrafiltration-only sessions with standard hemodialysis when considering medication clearance 4
• Be aware that pregabalin doses may need adjustment in patients with renal impairment, with approximately 50% reduction for each 50% decrease in creatinine clearance 1, 5
• Monitor for signs of pregabalin toxicity (myoclonus, altered mental status) in dialysis patients, especially those receiving isolated ultrafiltration who may accumulate the drug 3, 6
• Similar to pregabalin, other medications primarily eliminated by the kidneys (like gabapentin) also require standard hemodialysis with dialysate for significant removal 7

In summary, while pregabalin is effectively removed by standard hemodialysis with dialysate filtration, a dialysis session for fluid removal only will not significantly eliminate pregabalin from the body.