From the Guidelines
Pregabalin is contraindicated in patients with a history of angioedema, severe renal impairment, and known hypersensitivity to the drug or any of its components, and should be used with caution in patients with heart failure, history of substance abuse, and elderly patients or those taking other CNS depressants. When considering the use of pregabalin, it is essential to weigh the potential benefits against the risks, particularly in patients with certain comorbidities. According to the most recent evidence 1, pregabalin can cause adverse effects such as peripheral edema and fluid retention, which may worsen cardiac function in patients with heart failure. Some key points to consider when prescribing pregabalin include:
- Patients with severe renal impairment (creatinine clearance <15 mL/min) should avoid pregabalin or receive significantly reduced dosing with careful monitoring.
- Caution is necessary in patients with a history of substance abuse as pregabalin has potential for dependence and misuse.
- Pregabalin may cause CNS depression, so it should be used cautiously in elderly patients or those taking other CNS depressants.
- The medication should be used carefully in patients with a history of oedema, as it may exacerbate this condition, as noted in a previous study 1. It is crucial to carefully evaluate the patient's medical history and current health status before initiating pregabalin therapy, and to monitor them closely for potential adverse effects.
From the FDA Drug Label
- Contraindications Pregabalin is contraindicated in patients with known hypersensitivity to pregabalin or any of its components.
Pregabalin contraindications include:
- Known hypersensitivity to pregabalin or any of its components Pregabalin is contraindicated in patients with a history of hypersensitivity to the drug or its components, due to the risk of angioedema and hypersensitivity reactions 2
From the Research
Pregabalin Contraindications
Pregabalin is a medication used to treat various conditions, including neuropathic pain, epilepsy, and anxiety disorders. However, like all medications, it has potential contraindications and side effects.
- Heart Failure: There have been reports of heart failure associated with pregabalin use, particularly in elderly patients with pre-existing cardiac conditions 3, 4. The New York Heart Association has issued a warning to use caution when prescribing pregabalin to patients with type III-IV heart failure.
- Edema: Pregabalin can cause peripheral and central edema, which may be a concern for patients with heart failure or other conditions that affect fluid balance 3, 5.
- Hypersensitivity Reactions: There have been reports of hypersensitivity reactions to pregabalin, including fever, skin rash, and internal organ involvement 6.
- Other Side Effects: Common side effects of pregabalin include dizziness, somnolence, dry mouth, and weight gain 5.
Special Considerations
- Elderly Patients: Elderly patients with chronic diseases and cardiac history may be at higher risk of developing heart failure and edema when taking pregabalin 3.
- Patients with Cardiac Conditions: Patients with pre-existing cardiac conditions, such as heart failure, should be monitored closely when taking pregabalin 3, 7.
- Pregnancy and Breastfeeding: The safety of pregabalin during pregnancy and breastfeeding has not been well established, and it should be used with caution in these populations.
Studies on Pregabalin Contraindications
- A systematic review found that pregabalin is associated with a risk of heart failure and edema, although the strength of this association is not well characterized 4.
- A nationwide cohort study found no evidence to support an association between pregabalin use and increased risk of worsening heart failure, compared with gabapentin and duloxetine 7.