Can gabapentin (Neurontin) cause chest pains in adults with a history of neurological or psychiatric conditions?

Can Gabapentin Cause Chest Pain?

Gabapentin does not directly cause chest pain as a recognized adverse effect, but it can indirectly contribute to cardiovascular complications that may manifest as chest discomfort, particularly with long-term use in patients with diabetic neuropathy. 1, 2

Direct Adverse Effects of Gabapentin

The FDA-approved drug label for gabapentin lists the most common adverse reactions as:

• Dizziness (17-28% of patients) 1
• Somnolence (19-21% of patients) 1
• Peripheral edema (2-8% of patients) 1
• Ataxia and fatigue 1

Chest pain is not listed among the recognized adverse effects in the FDA label or major clinical guidelines. 1, 3

Indirect Cardiovascular Risks

Long-Term Cardiovascular Complications

A 2022 retrospective cohort study of 210,064 patients with diabetic neuropathy found that gabapentin use was associated with significantly increased 5-year cardiovascular risks: 2

• Myocardial infarction (HR: 1.25,95% CI 1.14-1.38) 2
• Heart failure (HR: 1.14,95% CI 1.07-1.21) 2
• Deep venous thrombosis (HR: 1.58,95% CI 1.37-1.82) 2
• Pulmonary embolism (HR: 1.5,95% CI 1.27-1.76) 2
• Stroke (HR: 1.31,95% CI 1.2-1.43) 2

Even short-term (3-month) gabapentin use showed significant associations with heart failure, myocardial infarction, and thromboembolic events. 2

Fluid Retention and Heart Failure

Gabapentin can cause dose-dependent peripheral edema, which may progress to central edema and heart failure in susceptible patients. 4 A case report documented a patient without cardiac history who developed peripheral edema progressing to central edema on 300 mg/day pregabalin (a closely related gabapentinoid), which resolved after discontinuation. 4 The mechanism is hypothesized to involve calcium channel effects, though not fully understood. 4

Atrial Fibrillation Risk

A 2023 case report documented new-onset atrial fibrillation in a young patient (20s) without comorbidities, occurring 4 days after starting gabapentin for lumbar radiculitis. 5 The arrhythmia resolved with cardioversion after gabapentin discontinuation. 5 While most evidence for gabapentin-associated atrial fibrillation involves elderly patients with comorbidities, this case demonstrates potential risk even in young, healthy individuals. 5

Clinical Context: Post-Surgical Chest Pain

Paradoxically, gabapentin is actually used to treat chronic post-sternotomy chest pain and paresthesia (PCPP), not cause it. 6, 7

• A prospective study of 45 thoracic surgery patients found that 73.3% experienced pain reduction with gabapentin (mean dose not specified, duration 21.9 weeks). 6
• A randomized trial comparing gabapentin 800 mg/daily versus diclofenac 75 mg/daily in 110 post-sternotomy patients found gabapentin superior in reducing chest pain scores (from 2.12±0.76 to 0.54±0.83, p<0.001) with effects lasting longer than diclofenac. 7
• Adverse effects in these studies were minor (somnolence, dizziness) occurring in 7% of gabapentin patients, with no cardiovascular complications reported. 6, 7

Critical Clinical Considerations

When to Suspect Gabapentin-Related Cardiovascular Issues

Evaluate for cardiovascular complications if a patient on gabapentin develops: 2, 4

• New-onset chest pain or pressure (consider myocardial infarction or heart failure)
• Progressive peripheral edema (may herald heart failure)
• Dyspnea or orthopnea (heart failure or pulmonary embolism)
• Palpitations or irregular pulse (atrial fibrillation)
• Unilateral leg swelling (deep venous thrombosis)

High-Risk Populations

Exercise particular caution when prescribing gabapentin to: 4, 2

• Patients with diabetic neuropathy (highest documented cardiovascular risk)
• Elderly patients with cardiac history (increased susceptibility to fluid retention and arrhythmias)
• Patients with pre-existing heart failure (New York Heart Association issued warnings about pregabalin in Class III-IV heart failure, which likely applies to gabapentin)

Monitoring Recommendations

For patients on long-term gabapentin therapy: 2, 4

• Monitor for peripheral edema at each visit (early sign of fluid retention)
• Assess cardiovascular symptoms regularly (chest pain, dyspnea, palpitations)
• Consider baseline and periodic ECG in high-risk patients (elderly, cardiac history)
• Maintain lowest effective dose (cardiovascular risks may be dose-dependent)

Common Pitfalls to Avoid

Do not dismiss new chest pain in gabapentin users as unrelated to the medication—investigate for myocardial infarction, heart failure, or pulmonary embolism, particularly in patients with diabetic neuropathy or prolonged use. 2

Do not assume gabapentin is cardiovascularly neutral because chest pain is not listed in the FDA label—emerging evidence demonstrates significant long-term cardiovascular risks. 2, 1

Do not confuse gabapentin's therapeutic use for post-surgical chest pain with it causing chest pain—these are distinct clinical scenarios. 6, 7