Adalimumab/duloxetine/pregabalin interaction
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First report of interactions, leading to exacerbation of peripheral neuropathy: case report A 22-year-old woman with type 1 diabetes mellitus and peripheral neuropathy experienced severe worsening of her neuropathy after adalimumab was added to her pain therapy with duloxetine and pregabalin. The woman, whose peripheral neuropathy had previously been well controlled with pregabalin 200mg three times daily and duloxetine SR 60mg daily [routes not stated], started receiving adalimumab injections for treatment of psoriasis and psoriatic arthritis. She received an initial dose of adalimumab 80mg, followed by 40mg at week 1 and 40mg every second week thereafter. Sensitivity in her feet markedly increased after the third adalimumab dose. After the fourth injection, she experienced severe worsening of peripheral neuropathy, manifesting as excruciating bilateral lower extremity pain. The woman’s duloxetine SR dosage was increased to 60mg twice daily, and her pain resolved. At the time of the report, she had been stable on the regimen for 36 months. Author comment: "The exact mechanism of interaction between adalimumab and either pregabalin, duloxetine, or a combination of both is unclear but may result in treatment limitations." Wu JJ, et al. Interaction between adalimumab with concurrent pregabalin and duloxetine administration in a psoriasis patient with diabetic peripheral neuropathy. 803060494 Cutis 87: 249-50, No. 5, May 2011 - USA
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports associated with an interaction between adalimumab and duloxetine or adalimumab and pregabalin. The WHO ADR database contained six reports associated with the concomitant use of adalimumab and duloxetine (including one report of drug ineffective), and 24 reports associated with the concomitant use of adalimumab and pregabalin (including one report of neuralgia, one of pain, seven of pain in extremity and one of diabetic neuropathy).
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Reactions 24 Sep 2011 No. 1370
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