The Lethal Combination of Pregabalin With Other Recreational Drugs

TL;DR

A 33-year-old man's severe health decline highlights the dangers of mixing pregabalin with recreational drugs like ketamine.

Contribution

This case emphasizes the risks of combining pregabalin with other neuroactive substances and the need for rapid clinical recognition.

Findings

The patient developed toxic-metabolic encephalopathy and acute kidney injury from pregabalin and ketamine use.

Prolonged multidrug abuse led to severe symptoms including delusions, hallucinations, and rhabdomyolysis.

The case underscores the importance of identifying psychiatric and toxicological factors in similar presentations.

Abstract

This case presents a 33-year-old male with a four-day history of worsening altered mental status and rhabdomyolysis. He experienced delusions, restlessness, and visual hallucinations, exacerbated by prolonged multidrug abuse, including over-the-counter pregabalin (Lyrica) for pain relief and recreational ketamine. Despite an initially incomplete history and unclear etiology, the patient was admitted for toxic-metabolic encephalopathy with acute kidney injury (AKI) and required significant medical management for confusion, acidosis, and electrolyte disturbances. This patient’s severe presentation serves as a caution against self-medicating with neuromodulators like pregabalin, especially alongside current or historical misuse of other neuroactive substances. This case affirms the necessity of swiftly discerning both clinical symptoms and psychiatric risk factors in the effective identification and treatment of dangerous pregabalin intoxication.