Can I take gabapentin with high blood pressure?

In this article:

• Can I take gabapentin with high blood pressure?
• Gabapentin and blood pressure
• Contraindications
• Tips for heart health
• The bottom line

In this article

• Can I take gabapentin with high blood pressure?
• Gabapentin and blood pressure
• Contraindications
• Tips for heart health
• The bottom line

Gabapentin, sold under the brand name Neurontin, is an anticonvulsant medication approved by the Food and Drug Administration (FDA) to treat partial seizures in people with epilepsy, restless leg syndrome, and the never pain caused by shingles (postherpetic neuralgia). It’s also frequently prescribed off-label for insomnia, alcohol withdrawal, irritable bowel syndrome, and mental health conditions like anxiety disorders. 

If you have high blood pressure, you may wonder whether it’s safe to take gabapentin. In most cases, gabapentin can be used safely by people with hypertension, but only after a healthcare provider evaluates your overall health, current medications, and cardiovascular risk. It’s essential to inform your doctor about any history of high blood pressure and to monitor your blood pressure readings regularly while taking gabapentin.

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Is gabapentin safe if you have high blood pressure?

“Gabapentin should be safe for people with high blood pressure to take,” says Cheng-Han Chen, MD, board-certified interventional cardiologist and medical director of the Structural Heart Program at Saddleback Medical Center in Laguna Hills, California. “Some studies have actually found that it can lower blood pressure somewhat.”

If you take medications for high blood pressure, it is essential that you monitor your blood pressure carefully while on gabapentin to make sure it doesn’t get too low due to the combined effects of both medications.

“Gabapentin, in general, is unlikely to worsen severe hypertension,” says Zergabachew Asfaw, MD, an internal medicine specialist practicing in the Bronx, New York. However, he notes that in people with poorly controlled blood pressure, the medication may increase symptoms like lightheadedness, drowsiness, or fatigue. These side effects of gabapentin can make it harder to distinguish medication-related issues from blood pressure-related symptoms. Because of this, your healthcare team should work together to monitor you closely.

Gabapentin and blood pressure

“Gabapentin is not generally known to elevate blood pressure,” Dr. Asfaw explains. In fact, it may slightly lower blood pressure in some individuals and can cause dizziness or orthostatic hypotension, a drop in blood pressure that occurs when standing. These effects stem from gabapentin’s action on calcium channels in the central nervous system, which play a role in regulating automatic functions such as heart rate and blood pressure.

Evidence from several animal studies suggests that gabapentin may lower blood pressure and heart rate by acting on key cardiovascular control centers in the brain, including the nucleus tractus solitarii (NTS), an important region involved in autonomic regulation. Although findings from animal research do not always translate directly to humans, some clinical data show a similar pattern. For example, one study found that giving gabapentin before surgery reduced the spike in blood pressure typically seen during laryngoscopy and intubation compared with a placebo.

Still, gabapentin is not without risks. “In certain rare cases, gabapentin has been linked to instances of heart failure,” notes Dr. Chen. One study also reported that long-term use of gabapentin and pregabalin (another drug with a similar mechanism of action) may increase the risk of cardiovascular complications such as heart failure and deep venous thrombosis in people with diabetic neuropathy. Similar adverse effects were observed in patients with fibromyalgia.

Because of these potential risks, gabapentin should be taken only under the supervision of a healthcare provider who has reviewed your medical history and current conditions. “People with heart disease should let their cardiologist know when starting gabapentin,” Dr. Chen advises. Always follow your provider’s guidance and discuss how long you should remain on the medication.

When should you not take gabapentin?

Though it’s okay for people with hypertension, gabapentin is not safe for everyone. Your healthcare provider will avoid prescribing it to you if you have a history of allergic reaction to it or any of its ingredients. Gabapentin may also not be ideal for you if:

• You are pregnant or trying to get pregnant
• You have kidney impairment
• You have certain other medical conditions, such as lung diseases or diabetes
• You are on a low-sodium or low-potassium diet (gabapentin oral solution typically contains sodium and potassium).
• You have a history of drug misuse or substance use disorder (gabapentin can be addictive, with studies reporting misuse, dependence, and abuse of the medication)

“Gabapentin may also be avoided if a person has uncontrolled depression and severe respiratory illnesses unless that person is monitored closely,” Dr. Asfaw says. “Those  who have severe swelling, new respiratory difficulties, and have complaints like severe imbalance or unsteadiness need to be reevaluated and have the medication stopped right away.”

Notably, gabapentin can interact with certain medications and food items, causing or worsening side effects and decreasing medication efficacy. Potential food and drug interactions include:

• Opioids, such as Roxicodone (oxycodone) and MS Contin (morphine sulfate)
• Antacids, particularly those that contain aluminum hydroxide or magnesium hydroxide
• CNS depressants, including sedatives, benzodiazepines, and antihistamines
• Alcohol
• Caffeine
  

Always seek medical advice from a healthcare professional before starting any new supplement or medication when taking gabapentin. Dr. Asfaw also notes that healthcare providers use gabapentin cautiously for older adults due to increased risk for adverse effects, including confusion, ataxia (poor muscle control that affects movement), and falling. “Any patient experiencing rapid changes in their mental state, neuromuscular coordination, and/or respiratory function should immediately stop the drug and seek medical attention,” he says. 

Supporting your heart health while on gabapentin

To support your heart health and promote healthy living while on gabapentin, Dr. Chen recommends you do the following:

• Eat a healthy, balanced diet. According to the American Heart Association, this includes a variety of fruits and vegetables, whole grains, legumes, nuts, low-fat dairy products, and lean and unprocessed meats. 
• Engage in regular physical activity. Aim for at least 150 minutes of exercise per week. You may consider doing 30 minutes per day spread out over five days. 
• Log an adequate amount of quality sleep. The expert recommendation is that you get at least 7 hours of sleep per night. 
• Maintain a healthy weight. Being overweight can increase blood pressure and other cardiovascular risk factors.
• Avoid tobacco and alcohol. Tobacco smoking and alcohol, especially excessive consumption (up to or more than three drinks per day), can increase the risk of heart-related conditions, such as hypertension, stroke, and atherosclerosis. 
• Reduce stress. Prolonged periods of mental distress can elevate blood pressure.
  

Additionally, to prevent unpredictable issues, Dr. Asfaw says people with hypertension should stick to a regular schedule when dosing their gabapentin and blood pressure medications. 

The bottom line

Gabapentin is generally safe for many people with high blood pressure, and it may even help lower blood pressure in some cases. Still, it’s essential to use it under the guidance of a healthcare provider who can monitor for side effects, such as dizziness, fatigue, or changes in blood pressure, especially when first starting the medication.

If you take other heart or blood pressure medicines, particularly beta blockers or calcium-channel blockers, your provider may recommend additional monitoring to ensure the medications work safely together. Always report new symptoms promptly and follow your care team’s recommendations to stay safe and protect your heart health.