From the Guidelines
Pregabalin can be associated with QT interval prolongation, particularly when used in combination with other medications that affect the QT interval or in patients with underlying cardiac conditions. Based on a case report from a 2018 study published in the European Heart Journal 1, a 76-year-old woman experienced a significantly prolonged QT interval (760 ms) after starting pregabalin, which normalized after the medication was withheld. This suggests that pregabalin may contribute to QT prolongation, especially in vulnerable patients or when combined with other QT-prolonging medications. Key points to consider include:
- The patient in the case report was also taking amiodarone and duloxetine, both of which can affect the QT interval.
- The QT interval normalized after all potentially offending medications, including pregabalin, were withheld.
- The mechanism of pregabalin's potential effect on the QT interval is not fully understood but may involve interactions with other medications or underlying cardiac conditions.
- Monitoring for QT interval prolongation and cardiac symptoms is recommended when initiating pregabalin, especially in patients with risk factors for QT prolongation or those taking other medications that may affect the QT interval.
From the Research
Pregabalin and QT Prolongation
- Pregabalin has been associated with QT interval prolongation, which may increase the risk of Torsades de Pointes (TdP), a potentially life-threatening cardiac arrhythmia 2.
- A study in humans found that pregabalin therapy was associated with prolonged QT interval, which returned to normal after discontinuation of the drug 2.
- Animal studies have also shown that pregabalin can prolong the QTc interval in a time- and dose-dependent manner 3.
- The mechanism of pregabalin-induced QT prolongation is not fully understood and requires further study 3.
- Clinicians should be aware of the potential risk of QT prolongation when prescribing pregabalin, particularly in patients with other risk factors for TdP, such as female sex, age >65 years, and uncorrected electrolyte disturbances 4.
Risk Factors for QT Prolongation
- Patient-related risk factors, such as female sex and age >65 years, can increase the risk of QT prolongation and TdP 4.
- The use of multiple QT-prolonging medications or medications that alter the pharmacokinetic profile of QT-prolonging drugs can also increase the risk of adverse outcomes 5.
- Clinicians should consider these risk factors when prescribing pregabalin and monitor patients for signs of QT prolongation and TdP 4.