Myoclonus in a Patient with Acute Kidney Injury: A Rare Presentation of Gabapentin Toxicity

Muzammil Khan¹, Shaza Khalid¹, Asghar Marwat¹, Salah Aldergash¹, Medha Joshi¹ and Varun Malhotra¹

¹Department of Internal Medicine, Conemaugh Memorial Medical Center/ Temple University, Johnstown, PA, USA

Cite this paper

Muzammil Khan, Shaza Khalid, Asghar Marwat, Salah Aldergash, Medha Joshi and Varun Malhotra. Myoclonus in a Patient with Acute Kidney Injury: A Rare Presentation of Gabapentin Toxicity. American Journal of Medical Case Reports. 2017; 5(8):232-233. doi: 10.12691/AJMCR-5-8-8

Abstract

Gabapentin, an anti-epileptic drug (AED) is commonly used off label for management of neuropathic pain and psychiatric disorders. Dosing of gabapentin requires taking into consideration the renal function as it is entirely cleared by the kidneys. Acute kidney injury and end stage renal disease increase the risk of developing myoclonic activity, an infrequent manifestation of gabapentin toxicity. We report a case of confusion and myoclonic activity related to gabapentin toxicity coincident with acute kidney injury that resolved with discontinuation of gabapentin and treatment with intravenous fluid hydration. As gabapentin is commonly used off label across multiple specialties, clinician recognition of the significance of renal dosing and understanding of the potential association with myoclonus and neurotoxicity is important.

Keywords

gabapentin toxicity

Copyright

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References

[1]	Backonja M, Beydoun A, Edwards KR, Schwartz SL, Fonseca V, Hes M, LaMoreaux L, Garofalo E, Gabapentin Diabetic Neuropathy Study Group. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA. 1998 Dec 2; 280(21): 1831-6.
[2]	Mack A. Examination of the evidence for off-label use of gabapentin. Journal of Managed Care Pharmacy. 2003 Nov; 9(6): 559-68.
[3]	Blum RA, Comstock TJ, Sica DA, Schultz RW, Keller E, Reetze P, Bockbrader H, Tuerck D, Busch JA, Reece PA, Sedman AJ. Pharmacokinetics of gabapentin in subjects with various degrees of renal function. Clinical Pharmacology & Therapeutics. 1994 Aug 1; 56(2): 154-9.
[4]	Catterall WA. Structure and regulation of voltage-gated Ca2+ channels. Annual Review of Cell and Developmental Biology. 2000 Nov; 16(1): 521-55.
[5]	Wong MO, Eldon MA, Keane WF, Türck D, Bockbrader HN, Underwood BA, Sedman AJ, Halstenson CE. Disposition of gabapentin in anuric subjects on hemodialysis. The Journal of Clinical Pharmacology. 1995 Jun 1; 35(6): 622-6.
[6]	Miller A, Price G. Gabapentin toxicity in renal failure: the importance of dose adjustment. Pain Medicine. 2009 Jan 1; 10(1): 190-2.
[7]	Hung TY, Seow VK, Chong CF, Wang TL, Chen CC. Gabapentin toxicity: an important cause of altered consciousness in patients with uraemia. BMJ Case Reports. 2009 Jan 1; 2009: bcr1120081268.
[8]	Guddati AK, Zafar Z, Cheng JT, Mohan S. Treatment of gabapentin-induced myoclonus with continuous renal replacement therapy. Indian Journal of Nephrology. 2012 Jan 1; 22(1): 59.
[9]	Zand L, McKian KP, Qian Q. Gabapentin toxicity in patients with chronic kidney disease: a preventable cause of morbidity. The American Journal of Medicine. 2010 Apr 30; 123(4): 367-73.