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Extracorporeal Treatment for Gabapentin and Pregabalin Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup

Research output: Contribution to journalArticlepeer-review

EXTRIP Workgroup

Original languageEnglish
Pages (from-to)88-104
Number of pages17
JournalAmerican Journal of Kidney Diseases
Volume79
Issue number1
DOIs
Accepted/In press2021
PublishedJan 2022

Bibliographical note

Funding Information: EXTRIP received support consisting of an unrestricted grant of $60,633 Canadian from the Verdun Research Fund (the institution of Dr Ghannoum) solely for the reimbursement of travel expenses for the in-person guideline meeting and payment to dedicated translators for retrieval and translation of foreign language articles. Funding Information: Badria Alhatali, Kurt Anseeuw, Steven Bird, Ingrid Berling, Timothy E. Bunchman, Paul K. Chin, Kent Doi, Tais Galvao, David S. Goldfarb, Hossein Hassanian, Lotte C.G. Hoegberg, Siba Kallab, Sofia Kebede, Jan T. Kielstein, Andrew Lewington, Etienne M. Macedo, Rob MacLaren, Bruno Megarbane, James B. Mowry, Thomas D. Nolin, Jean-Philippe Roy, Anitha Vijayan, Steven J. Walsh, Anselm Wong, and David M. Wood. Jos?e Bouchard, MD, Christopher Yates, MD, Diane P. Calello, MD, Sophie Gosselin, MD, Darren M. Roberts, MBBS, PhD, Val?ry Lavergne, MD, MSc, Robert S. Hoffman, MD, Marlies Ostermann, MD, PhD, Ai Peng, MD, and Marc Ghannoum, MD, MSc. EXTRIP received support consisting of an unrestricted grant of $60,633 Canadian from the Verdun Research Fund (the institution of Dr Ghannoum) solely for the reimbursement of travel expenses for the in-person guideline meeting and payment to dedicated translators for retrieval and translation of foreign language articles. Dr Ghannoum is a scholar of the Fonds de Recherche du Qu?bec, Sant?. Dr Roberts acknowledges support of St. Vincent's Centre for Applied Medical Research Clinician ?Buy-Out? Program. Dr Ostermann has received speaker honoraria and research funding from Fresenius Medical, Baxter, and LaJolla Pharma and has had consulting functions for Biomerieux, Nxstage, and Baxter. From the EXTRIP Workgroup members, Dr Nolin reports personal fees from MediBeacon, CytoSorbents, and McGraw-Hill Education outside the submitted work, and Dr Vijayan reports consulting functions for NxStage, Astute Medical, and Boehringer-Ingelheim and speaker fees from Sanofi-Aventis. The remaining authors declare that they have no relevant financial interests. We would like to acknowledge the valuable help of our dedicated translators, librarian, data extractors, and meeting secretary. Official translators were Alexandra Angulo, Alla Abbott, Anant Vipat, Andreas Betz, Angelina Kovaleva, Denise Gemmellaro, Ewa Brodziuk, Helen Johnson, Junzheng Peng, Marcela Covic, Nathalie Eeckhout, Rosie Finnegan, Salih Topal, and Vilma Etchard. The librarian was Elena Guadagno. Data extractors for EXTRIP-2 included Maria Rif, Fran?ois Filion, Karine Mardini, Maria Rif, Tudor Botnaru, Elizabeth Koo, and Gabrielle Wilson. The meeting secretary was Brenda Gallant. Received February 27, 2021. Evaluated by 2 external peer reviewers, with direct editorial input from an Associate Editor and a Deputy Editor. Accepted in revised form June 11, 2021. Funding Information: Dr Ghannoum is a scholar of the Fonds de Recherche du Québec, Santé. Dr Roberts acknowledges support of St. Vincent’s Centre for Applied Medical Research Clinician “Buy-Out” Program. Dr Ostermann has received speaker honoraria and research funding from Fresenius Medical, Baxter, and LaJolla Pharma and has had consulting functions for Biomerieux, Nxstage, and Baxter. From the EXTRIP Workgroup members, Dr Nolin reports personal fees from MediBeacon, CytoSorbents, and McGraw-Hill Education outside the submitted work, and Dr Vijayan reports consulting functions for NxStage, Astute Medical, and Boehringer-Ingelheim and speaker fees from Sanofi-Aventis. The remaining authors declare that they have no relevant financial interests. Publisher Copyright: © 2021 National Kidney Foundation, Inc.

King's Authors

Abstract

Toxicity from gabapentin and pregabalin overdose is commonly encountered. Treatment is supportive, and the use of extracorporeal treatments (ECTRs) is controversial. The EXTRIP workgroup conducted systematic reviews of the literature and summarized findings following published methods. Thirty-three articles (30 patient reports and 3 pharmacokinetic studies) met the inclusion criteria. High gabapentinoid extracorporeal clearance (>150 mL/min) and short elimination half-life (<5 hours) were reported with hemodialysis. The workgroup assessed gabapentin and pregabalin as “dialyzable” for patients with decreased kidney function (quality of the evidence grade as A and B, respectively). Limited clinical data were available (24 patients with gabapentin toxicity and 7 with pregabalin toxicity received ECTR). Severe toxicity, mortality, and sequelae were rare in cases receiving ECTR and in historical controls receiving standard care alone. No clear clinical benefit from ECTR could be identified although major knowledge gaps were acknowledged, as well as costs and harms of ECTR. The EXTRIP workgroup suggests against performing ECTR in addition to standard care rather than standard care alone (weak recommendation, very low quality of evidence) for gabapentinoid poisoning in patients with normal kidney function. If decreased kidney function and coma requiring mechanical ventilation are present, the workgroup suggests performing ECTR in addition to standard care (weak recommendation, very low quality of evidence).

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