Flumazenil therapy for a gabapentin‑induced coma: a case report

J Med Case Reports, 2021 · DOI: https://doi.org/10.1186/s13256-021-02816-3 · Published: May 12, 2021

Pharmacology Neurology Research Methodology & Design

Simple Explanation

This case report discusses a situation where a patient taking gabapentin, a drug for nerve pain and muscle spasms, experienced a coma-like state. The patient had a spinal cord injury and was also taking other medications. After standard tests came back normal, doctors suspected the gabapentin might be the cause. They administered flumazenil, a drug typically used to reverse the effects of benzodiazepines, and the patient quickly regained consciousness. The report suggests that flumazenil might have uses beyond reversing benzodiazepines and highlights the need to understand how people react differently to medications, especially gabapentin.

Study Duration

7 Months

Participants

One 70-year-old Caucasian man

Evidence Level

Level 4: Case Report

Key Findings

1
A 70-year-old man with tetraplegia developed a coma after gabapentin administration, despite normal renal and liver function.
2
Intravenous flumazenil (0.20 mg) resulted in rapid and complete neurocognitive recovery within 30 seconds.
3
The case suggests a possible off-label use for flumazenil in reversing gabapentin-induced coma, even in the absence of renal failure or acute brain injury.

Research Summary

This case report presents a rare instance of a gabapentin-induced coma in a patient with spinal cord injury, successfully reversed by flumazenil. The patient, a 70-year-old man with tetraplegia, experienced a sudden loss of consciousness despite normal vital signs, brain imaging, and blood tests. The successful use of flumazenil suggests a potential mechanism beyond its known benzodiazepine antagonist action and calls for further research into gabapentin and flumazenil pharmacodynamics.

Practical Implications

Expanded Flumazenil Use

Consider flumazenil as a potential antidote in cases of unexplained coma in patients taking gabapentin, even without signs of renal failure or benzodiazepine use.

Individual Variability in Drug Response

Recognize the importance of individual patient responses to medications, particularly gabapentin, and monitor for unexpected adverse effects.

Further Research Needed

Conduct further studies to elucidate the mechanisms of action of gabapentin and flumazenil, and to investigate potential interactions between gabapentin and other medications like baclofen.

Study Limitations

1
Single case report limits generalizability.
2
Lack of detailed mechanistic investigation to confirm the exact interaction between gabapentin and flumazenil.
3
Potential confounding factors from other medications the patient was taking.

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