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The Annals of Pharmacotherapy: Vol. 37, No. 1, pp. 74-76. DOI 10.1345/aph.1C242
© 2003 Harvey Whitney Books Company.
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Flumazenil and Dialysis for Gabapentin-Induced Coma

Toni C Butler, MD

Resident, Department of Surgery, Bassett Healthcare, Cooperstown, NY

Raquel M Rosen, MD

Attending Physician, Division of Nephrology, Department of Adult and Pediatric Medicine, Bassett Healthcare

Allison L Wallace, PharmD

Pharmacy Resident, Bassett Healthcare

Guy W Amsden, PharmD

Clinical Pharmacy Specialist and Research Scientist, Clinical Pharmacology Research Center, Department of Adult and Pediatric Medicine, Bassett Healthcare

Reprints: Guy W Amsden PharmD, Clinical Pharmacology Research Center, Bassett Healthcare, One Atwell Rd., Cooperstown, NY 13326-1394, FAX 607/547-6914, E-mail guy.amsden{at}bassett.org

OBJECTIVE: To describe a case of gabapentin-induced coma that was reversed with flumazenil and hemodialysis.

CASE SUMMARY: We describe an 83-year-old dialysis-dependent white man who became comatose after a single dose of gabapentin for phantom limb pain. The patient was successfully revived from the coma with administration of flumazenil, which was then followed by hemodialysis. Serum concentration data before and 4 hours after dialysis document the effectiveness of hemodialysis for gabapentin toxicity.

DISCUSSION: An objective causality assessment revealed that this adverse event was probably related to the gabapentin that the patient received. To our knowledge, this is the first documented case of not only gabapentin-induced coma, but also the effectiveness of flumazenil for treatment of this type of coma. Although therapeutic hemodialysis has been previously described, our case report is strengthened by the serum concentration monitoring accompanying it.

CONCLUSIONS: This report underscores the importance of initiating gabapentin therapy at low doses in dialysis-dependent patients and introduces a novel treatment for those who experience toxicity.

Key Words: flumazenil, gabapentin, hemodialysis

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