Is Gabapentin Hard on the Heart? Understanding Potential Risks

October 10, 2025 •

3 min read

While commonly prescribed for neuropathic pain and seizures, recent research and clinical case reports have raised questions about whether is gabapentin hard on the heart. Studies indicate a potential link between long-term use and an increased risk of adverse cardiovascular events, especially in at-risk patients.

Quick Summary

Gabapentin, used for pain and seizures, poses risks for adverse cardiovascular events like heart failure and arrhythmias, particularly with long-term use and in vulnerable patients. Fluid retention is a key contributing factor.

Key Points

Fluid Retention Risk: Gabapentin can cause peripheral edema (fluid retention), which can precipitate or worsen congestive heart failure, particularly in at-risk patients.
Increased Adverse Event Risk: Long-term use of gabapentin has been associated with an increased risk of heart failure, myocardial infarction, stroke, deep venous thrombosis, and pulmonary embolism, especially in patients with diabetic neuropathy or fibromyalgia.
Potential for Arrhythmias: Case reports and observational studies have linked gabapentin to an increased risk of heart rhythm abnormalities, including atrial fibrillation.
Higher Risk in Vulnerable Populations: The elderly, individuals with pre-existing heart conditions, and patients with renal impairment are at a higher risk for gabapentin-induced cardiovascular adverse effects.
Mechanism of Action Affects Calcium Channels: The drug's mechanism involving voltage-gated calcium channels may explain its effects on heart contractility and rhythm.
Dose-Dependent Risk: Some studies suggest that the risk of heart rhythm abnormalities is dose-dependent, with higher doses carrying a greater risk.
Careful Monitoring is Recommended: For patients with existing heart conditions, doctors should start with a low dose and monitor closely for signs of fluid retention or worsening heart symptoms.

Gabapentin is an anticonvulsant medication used for conditions like neuropathic pain and epilepsy. While long considered relatively safe compared to opioids, growing evidence from various studies, including case reports and large retrospective analyses, suggests a potential link between gabapentin use and significant cardiovascular side effects, particularly with long-term use and in vulnerable patients like the elderly or those with existing heart conditions.

The Role of Fluid Retention and Heart Failure

Peripheral edema, or fluid retention, is a known cardiovascular side effect of gabapentin that can be significant for individuals with heart conditions by increasing strain on the heart and potentially worsening congestive heart failure (CHF). Case reports highlight instances of gabapentin-induced CHF that resolved after discontinuing the medication. Experts advise cautious monitoring for fluid retention and a reduced initial dose when restarting gabapentin after a CHF exacerbation. The mechanism is thought to involve gabapentin's effects on calcium channels that influence blood vessel tone, leading to vasodilation and increased intravascular fluid, which is particularly risky for those with impaired heart function.

Long-Term Use and Broader Cardiovascular Risks

Large retrospective studies have also linked the long-term use of gabapentin and pregabalin to broader cardiovascular risks.

Studies on Diabetic Neuropathy and Fibromyalgia

A study in Cardiovascular Diabetology involving over 210,000 patients with diabetic neuropathy showed higher risks for adverse cardiovascular events in gabapentin users over 5 years. A separate study in PLOS ONE from 2024 found similar links between long-term gabapentin use and increased risk of PVD, MI, heart failure, DVT, and PE in fibromyalgia patients over a 5-year period. These studies indicate that the risks extend beyond heart failure to major vascular events.

Gabapentin and Cardiac Arrhythmias

Gabapentin has also been associated with heart rhythm disturbances, such as atrial fibrillation (A-Fib), the most common sustained cardiac arrhythmia. A case report in the Journal of Medical Case Reports described new-onset A-Fib shortly after starting gabapentin. The risk of arrhythmia may be dose-dependent and potentially linked to gabapentin's interaction with voltage-gated calcium channels important for heart rhythm regulation.

Comparing Cardiovascular Risks: Gabapentin vs. Alternatives

Considering potential risks versus benefits is crucial in prescribing. Compared to some alternatives, gabapentin's cardiovascular risks, including heart failure, MI, stroke, DVT, PE, and fluid retention, appear distinct. Risks are higher in vulnerable populations like the elderly, those with existing heart disease, and those with renal impairment, where gabapentin clearance is a significant factor.


Feature	Gabapentin	Alternative Drugs
Cardiovascular Risk (Long-Term)	Linked to increased risk of heart failure, MI, stroke, DVT, and PE.	Some alternatives like opioids also carry risks, but gabapentin-related risks appear distinct.
Fluid Retention (Edema)	A well-known side effect that can precipitate heart failure in vulnerable patients.	Varies by drug. Opioids are not associated with edema; some NSAIDs and other drugs can cause it.
Arrhythmias	Case reports and studies link it to increased risk of atrial fibrillation, especially in the elderly.	Risks vary significantly among different drug classes.
Vulnerable Populations	Risks are higher in the elderly, those with pre-existing heart disease, and renal impairment.	Considerations vary depending on the specific alternative and patient's health profile.
Renal Impairment	The risk for adverse effects, including cardiovascular ones, is significantly increased in patients with renal impairment due to reduced clearance.	Requires careful dosage adjustment for most medications, but gabapentin clearance is highly dependent on kidney function.

Clinical Implications and Precautions

Given these findings, physicians should be cautious when prescribing gabapentin, particularly to the elderly or those with cardiovascular disease. A careful risk-benefit analysis is necessary. Using the lowest effective dose and closely monitoring for fluid retention and other cardiovascular symptoms, especially in patients with comorbidities, are important precautions.

Conclusion

The question 'is gabapentin hard on the heart?' has a complex answer. While likely safe for healthy individuals in the short term, evidence indicates that long-term use and pre-existing heart conditions increase the risk of serious adverse cardiac and vascular events, including heart failure and arrhythmias. Awareness of these risks and careful monitoring are crucial for safe treatment, as is considering alternatives for high-risk individuals.

Frequently Asked Questions

Yes, case reports and studies suggest that gabapentin can cause irregular heart rhythms, including heart palpitations and atrial fibrillation, particularly in elderly patients or those with pre-existing heart conditions.

Gabapentin should be used with caution in individuals with pre-existing heart disease, as they are at a higher risk for developing adverse cardiovascular effects, including heart failure and arrhythmias. A thorough risk-benefit analysis by a healthcare provider is essential.

In some animal models and acute settings like surgery, gabapentin has been shown to cause temporary decreases in blood pressure and heart rate. Chronic effects on blood pressure in humans are less clear, and some cases of hypertension have been noted as a cardiovascular side effect.

Gabapentin can affect the heart by causing fluid retention, which puts extra strain on the organ and can lead to or worsen heart failure. It may also interfere with cardiac calcium channels, potentially causing arrhythmias.

Yes, gabapentin can cause peripheral edema (swelling) and, in some cases, lead to the development or decompensation of congestive heart failure, which includes symptoms like shortness of breath.

Cardiovascular side effects can sometimes appear shortly after starting the medication, with case reports describing issues like heart failure emerging within days. However, some risks are associated with longer-term use, seen in multi-year studies.

Some evidence suggests that the risk of certain cardiac side effects, such as atrial fibrillation, may be dose-dependent, with higher doses correlating with greater risk. Discussing the lowest effective dose with a healthcare provider is prudent.