From the Guidelines
Mexiletine does not typically lower blood pressure, and patients with hypertension should not rely on it as a treatment for high blood pressure. Mexiletine is primarily classified as a Class IB antiarrhythmic medication used to treat ventricular arrhythmias and certain types of chronic pain, particularly neuropathic pain. Unlike many cardiovascular medications, mexiletine works by blocking sodium channels in cardiac cells, which helps stabilize heart rhythm without significantly affecting blood pressure. This mechanism of action differs from antihypertensive medications that target blood vessels, sympathetic nervous system, or fluid balance to reduce blood pressure, as discussed in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
Some key points to consider when managing hypertension include:
- The use of combination therapy with multiple antihypertensive agents, which can have additive or synergistic effects and lead to greater blood pressure reduction 1
- The recommendation of certain drug classes, such as ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics, as first-line options for starting hypertension treatment in the general population 1
- The importance of lifestyle modification and adherence to treatment regimens in achieving blood pressure goals, as emphasized in the 2018 ACC/AHA/AAPA/ABC/ACPM/AGS/APHA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1
Patients taking mexiletine for arrhythmias or pain management should not expect it to help control hypertension, and those with high blood pressure will still need dedicated antihypertensive medications. Common side effects of mexiletine include gastrointestinal disturbances, dizziness, and tremor, but significant blood pressure changes are not typically observed with this medication. Therefore, mexiletine should not be used as a primary treatment for hypertension, and other evidence-based treatments should be prioritized to manage high blood pressure effectively.
From the FDA Drug Label
Hemodynamic studies in a limited number of patients, with normal or abnormal myocardial function, following oral administration of mexiletine hydrochloride, have shown small, usually not statistically significant, decreases in cardiac output and increases in systemic vascular resistance, but no significant negative inotropic effect Blood pressure and pulse rate remain essentially unchanged.
Mexiletine does not lower Blood Pressure (BP), as it has been shown that blood pressure remains essentially unchanged in patients taking the medication 2.
From the Research
Effects of Mexiletine on Blood Pressure
- There is no direct evidence in the provided studies that mexiletine lowers blood pressure (BP) 3, 4, 5, 6, 7.
- The studies primarily focus on the antiarrhythmic effects of mexiletine, its pharmacokinetics, and its therapeutic use in treating arrhythmias.
- Some studies mention the hemodynamic effects of mexiletine, stating that it has minimal effects on haemodynamic variables or cardiac function in patients with or without pre-existing deterioration of left ventricular function 4, 5.
- However, none of the studies explicitly investigate or report the effect of mexiletine on blood pressure.
Hemodynamic Effects of Mexiletine
- Mexiletine has been shown to have minimal negative inotropic effect compared to other antiarrhythmic agents like procainamide or disopyramide 5.
- It does not depress myocardial function, and aggravation of arrhythmias is uncommonly observed 3.
- The drug's hemodynamic tolerance is generally good, with minimal effects on cardiac function or haemodynamic variables 4, 6.
Conclusion Not Applicable
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No Further Information Available
- There are no further details available on the effect of mexiletine on blood pressure from the provided studies.