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Rash Associated with Pregabalin Use

PharmD Student, College of Pharmacy, University of Kentucky, Lexington, KY

Aaron Baldwin, DMD

Resident in Oral and Maxillofacial Surgery, University of Kentucky

Larry L Cunningham Jr, DDS MD FACS

Associate Professor and Residency Director, Oral and Maxillofacial Surgery, University of Kentucky

Aaron M Cook, PharmD

Pharmacy Specialist—Neurosurgery/Critical Care, UKHealthCare; Assistant Adjunct Professor, College of Pharmacy, University of Kentucky

Reprints: Dr. Cook, College of Pharmacy, University of Kentucky, 800 Rose St. H110, Lexington, KY 40536, fax 859/323-2049, amcook0{at}email.uky.edu

OBJECTIVE: To report a case of extensive rash induced by orally administered pregabalin in a patient with neuropathic pain.

CASE SUMMARY: A 35-year-old white female with a diffuse, erythematous, maculopapular rash localized to her back and extremities presented to the preoperative holding area for planned exploratory nerve surgery. Prior to presentation, she had been receiving oral pregabalin 50 mg 3 times a day for approximately 2 weeks to treat her neuropathy. Prior to pregabalin therapy, the patient indicated that she had taken gabapentin for approximately 3 weeks for the pain, but had discontinued it due to adverse effects and perceived lack of efficacy. Pregabalin was discontinued and diphenhydramine and methylprednisolone were given to treat the rash. The rash almost completely resolved one week after pregabalin was discontinued.

DISCUSSION: Pregabalin-induced rash was rarely reported in Phase 3 trials, and a clinical description of such events has not been published. Pregabalin exhibits pharmacokinetics different from those of most other antiepileptic agents. Presently, there are no clear mechanisms known for rash associated with pregabalin. The Naranjo probability scale indicates a probable relationship between the development of rash and use of pregabalin by our patient.

CONCLUSIONS: There are currently no other available reports of the development of a rash coinciding with the use of pregabalin. As both Food and Drug Administration-approved and off-label use of this drug increases, further consideration of risk factors associated with the development of rash is needed.

Key Words: antiepileptic drug, pregabalin, rash

Published Online, November 11, 2008. www.theannals.com, DOI 10.1345/aph.1L305