Therapeutic Drug Monitoring of Pregabalin in a Critically ill Patient with Acute Kidney Injury undergoing Continuous, Prolonged Intermittent, and Intermittent Kidney Replacement Therapy

Author(s): Francesca Di Mario, Eleonora Galosi, Paolo Greco, Caterina Maccari, Brenda Menegazzo, Teresa Coccini, Elisa Roda, Enrico Fiaccadori

Pregabalin is an anti-epileptic drug which also represents one of the most frequently prescribed medications for neuropathic pain management worldwide. Moreover, in recent years its use has widely increased also in critically ill patients in the setting of multimodal analgesia. Commonly available as capsules and oral solution, it is characterized by a predominant kidney elimination. Consequently, in patients with kidney failure posology adjustments are needed. According to the pharmacokinetic parameters (low molecular weight and volume of distribution, negligible protein binding), pregabalin is expected to undergo a significant extracorporeal clearance, which should be taken into account when one of the different Kidney Replacement Therapy (KRT) modalities is required for Acute Kidney Injury (AKI). The case of a critically ill patient with AKI undergoing Therapeutic Drug Monitoring of Pregabalin in course of Continuous, Prolonged Intermittent KRT (CKRT and PIKRT, respectively), and conventional intermittent hemodialysis (IHD) is presented here for the first time.