Abstract
A 65-year-old man who underwent liver transplantation three years ago had severe renal failure caused by nephrosclerosis. He was managed with immunosuppressive therapy against rejection. He suffered from acute herpetic pain in his left chest and back for 13 days and received medical treatment. We started pregabalin at 25 mg/day. Although the pain was improved, we stopped pregabalin 8 days later because of adverse effects, i.e., dizziness and balance disorder. Hemodialysis was introduced for aggravation of the renal function 10 days later. Even though the adverse effects were gone after the hemodialysis, the pain recurred. Therefore we resumed pregabalin at 12.5 mg/day. The pain was improved, and the adverse effects were mimimal. Hepatic encephalopathy gradually worsened, so we stopped again pregabalin. Because pregabalin is eliminated by kidney, it should be strictly titrated in patients with renal failure. Differential diagnosis would be needed for hepatic encephalopathy and the adverse effects of pregabalin in severe hepatic failure.
