JAMA Netw Open

Heart failure risk higher with pregabalin than gabapentin in older adults

August 5, 2025

Pregabalin should be prescribed with caution in older adults, particularly those with CV comorbidities, as it confers a higher risk of incident heart failure (HF) compared with gabapentin. This supports current recommendations from the European Medicines Agency to exercise caution with pregabalin in this population.

Study details: A large retrospective cohort study analyzed 246,237 Medicare beneficiaries aged 65 to 89 years with chronic noncancer pain and no prior HF, comparing new users of pregabalin (n = 18,622) vs. gabapentin (n = 227,615). Primary outcome was hospital admission or ED visit for HF, with secondary outcomes including outpatient HF diagnosis and all-cause mortality. Propensity score adjustment accounted for 231 covariates.

Results: Pregabalin initiation was associated with a higher incidence of HF compared with gabapentin (18.2 vs. 12.5 per 1,000 person-years; adjusted hazard ratio [AHR], 1.48; 95% confidence interval [CI], 1.19–1.77). The risk was further elevated in patients with pre-existing CVD (AHR, 1.85; 95% CI, 1.38–2.47). Outpatient HF diagnoses were also more frequent with pregabalin (AHR, 1.27; 95% CI, 1.02–1.58). All-cause mortality didn't differ significantly between groups.

Source:

Park EE, et al. (2025, August 1). JAMA Netw Open. Initiation of Pregabalin vs Gabapentin and Development of Heart Failure. https://pubmed.ncbi.nlm.nih.gov/40748640/