Risk of Heart Failure in Pregabalin and Gabapentin Usage
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on September 5th, 2025
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Pregabalin and gabapentin are frequently used to manage chronic pain. These gabapentinoids are preferred over opioids due to the risk of addiction development. However, these medications are associated with risk of cardiovascular side effects, but there is still a lack of thorough understanding. With funding from the United States National Institute of Arthritis and Musculoskeletal and Skin Diseases, a study was conducted to assess the cardiovascular risk of pregabalin and gabapentin usage.
The retrospective cohort analysis drew on health records from approximately 246,000 patients between 2015 and 2018. The median age of the cohort was 73 years. Of these, over 220,000 were taking gabapentin, while about 18,000 were on pregabalin. Prescriptions were primarily for back pain (68%), neuropathic pain (60%), and arthralgia (48.5%). A large proportion of patients also had pre-existing conditions, including hypertension (79.2%), ischemic stroke (9.8%), and myocardial infarction (3.4%).
Both pregabalin and gabapentin decrease the sensation of pain by binding to the neuronal voltage-gated calcium channels on neurons to reduce neurotransmitter release. This form of calcium channel is also expressed on cardiomyocytes; thus, the interaction from these medications can interfere with the normal cardiac function, resulting in heart failure and edema.
After analysis, the researchers found that the rate of heart failure is 48% higher in patients who used pregabalin than those who used gabapentin. This association is true for patients who have a history of cardiovascular disease, with the risk increased to 80%. These findings can be explained by the fact that pregabalin has a higher affinity for the calcium channel than gabapentin. It is important to note that this study used health records of patients above the age of 65 years old. This advanced age is associated with a higher risk of severe cardiovascular problems; therefore, future study should advance the generalizability of these findings by examining younger patients with a lower risk of cardiovascular disease.
The retrospective cohort analysis drew on health records from approximately 246,000 patients between 2015 and 2018. The median age of the cohort was 73 years. Of these, over 220,000 were taking gabapentin, while about 18,000 were on pregabalin. Prescriptions were primarily for back pain (68%), neuropathic pain (60%), and arthralgia (48.5%). A large proportion of patients also had pre-existing conditions, including hypertension (79.2%), ischemic stroke (9.8%), and myocardial infarction (3.4%).
Both pregabalin and gabapentin decrease the sensation of pain by binding to the neuronal voltage-gated calcium channels on neurons to reduce neurotransmitter release. This form of calcium channel is also expressed on cardiomyocytes; thus, the interaction from these medications can interfere with the normal cardiac function, resulting in heart failure and edema.
After analysis, the researchers found that the rate of heart failure is 48% higher in patients who used pregabalin than those who used gabapentin. This association is true for patients who have a history of cardiovascular disease, with the risk increased to 80%. These findings can be explained by the fact that pregabalin has a higher affinity for the calcium channel than gabapentin. It is important to note that this study used health records of patients above the age of 65 years old. This advanced age is associated with a higher risk of severe cardiovascular problems; therefore, future study should advance the generalizability of these findings by examining younger patients with a lower risk of cardiovascular disease.