From the Research
Gabapentin is associated with an increased risk of adverse cardiovascular events, including heart failure, myocardial infarction, peripheral vascular disease, stroke, deep venous thrombosis, and pulmonary embolism, in patients with coronary artery disease (CAD). This is based on the findings of a study published in 2022, which examined the cardiovascular risk of gabapentin and pregabalin in patients with diabetic neuropathy 1. The study found that both gabapentin and pregabalin were associated with an increased risk of adverse cardiovascular events, with the highest risk observed for deep venous thrombosis and pulmonary embolism.
Key Findings
- Gabapentin and pregabalin are associated with an increased risk of adverse cardiovascular events in patients with diabetic neuropathy 1
- The risk of adverse cardiovascular events is higher with long-term use of gabapentin and pregabalin 1
- Patients with CAD and diabetic neuropathy should be monitored closely for signs of cardiovascular disease when taking gabapentin or pregabalin 1
- Gabapentin works by binding to calcium channels in the nervous system, not through mechanisms that would worsen cardiac conditions, but may cause peripheral edema, which can exacerbate heart failure symptoms in CAD patients with reduced ejection fraction
Clinical Implications
- Gabapentin can be used in CAD patients without significant cardiovascular concerns, but with caution and close monitoring for signs of cardiovascular disease
- The standard dosing for gabapentin starts at 300mg once daily, gradually increasing to 300mg three times daily, with further titration as needed up to 1800-3600mg daily divided into three doses
- For elderly patients or those with renal impairment, lower doses and slower titration are recommended
- Gabapentin has minimal drug interactions with common cardiac medications, making it a safer choice compared to some other pain or seizure medications that might affect cardiac function or interact with anticoagulants or antiplatelets commonly prescribed in CAD 2, 3