Revisiting Gabapentin Safety: A Rare Case of Serious Angioedema
V S Chirag Gowda *
Department of Pharmacy Practice, PES University, Bengaluru, India.
Manjari Sharma
Department of Pharmacy Practice, PES University, Bengaluru, India.
Akshay TM
Department of Orthopaedics, PES Institute of Medical Sciences and Research, Bengaluru, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Gabapentin offers an excellent safety profile and is frequently prescribed to treat neuropathic pain. However only three instances of angioedema have been documented in the published literature, Resulting in a very rare side effect. Early recognition can be challenging as the presentation may mirror common postoperative oedema or even be misinterpreted as a surgical complication.
Case Presentation: A 61year old male patient was prescribed gabapentin for neuropathic pain right after lumbar decompression surgery. He developed mild dysphagia and sudden swelling of the right periorbital and malar regions within 24 hours, but his airway function was unaffected. ACE inhibitor related angioedema. Fluid overload and contact hypersensitivity are all ruled out as potential reasons. An isolated increase in CRP was identified through laboratory analysis.
Management and Outcome: Gabapentin was stopped immediately, for managing pain pregabalin –nortriptyline was started. Antihistamines and corticosteroids administered intravenously showed a noticeable improvement and within 36 hours oedema had completely disappeared The Naranjo scale revealed a probable causal relationship between gabapentin and angioedema.
Conclusion: This case illustrates the important role of pharmacovigilance in postoperative pain management is highlighted in this case .gabapentin can cause severe allergic reactions such as angioedema ,which is rare .quick recovery was achieved possibly by prompt identification and rapid drug withdrawal , which also prevented complications like airway compromise .when prescribing gabapentin or similar class drugs ,clinicians must be vigilant ,take a complete drug allergy history and consider angioedema into consideration .
Keywords: Gabapentin, angioedema, adverse drug reaction, neuropathic pain