The impact of high doses of pregabalin on pregnancy – case report

Pregabalin is a medication which is classified as a close analogue of gamma-aminobutyric acid. It has been modified to be a lipophilic analogue to enhance diffusion across the blood–brain barrier. Pregabalin was approved for the treatment of neuropathic pain associated with diabetic peripheral neuropathy, spinal cord injury, postherpetic neuralgia, and fibromyalgia, and as an adjunctive therapy for partial-onset seizures. In recent years, this medicament has also been used in the treatment of generalized and social anxiety disorder, bipolar disorder, chronic pain, and insomnia. The United States Food and Drug Administration categorized pregabalin to the pregnancy category C. The authors present the case of a 27-year-old female with mixed anxiety and depressive disorder who overused pregabalin (3000 mg per day) and was four months pregnant. The patient reported mood reduction and problems with falling asleep. The patient had a negative response to treatment. On the fourth day of hospitalization, she left the department at her own request. Five months later, she was admitted to the Maternity Ward with the beginning of delivery in the 36th week of pregnancy. During the entire pregnancy, the woman took pregabalin in the maximum dose of 3000 mg per day and smoked cigarettes. The child weighed 3450 g, measured 54 cm and was born with congenital pneumonia. One year after her first hospitalization, the patient came to the Detoxification Department with withdrawal syndrome, including anxiety, tremors, diarrhoea, abdominal pain, and sleeping problems. This time, in addition to her overuse of pregabalin (3000 mg per day), she became addicted to tramadol (750 mg per day). We concluded that pregabalin is not seriously toxic to the patient and foetus. It should be noted that pregabalin may have potential addictive effects.