Over-the-counter pain relievers blamed for mistaken diagnosis of heart failure

A new study indicates that a popular non-opioid painkiller class may be leading physicians to incorrectly diagnose heart failure. Researchers report that medications such as gabapentin and pregabalin, routinely used to manage nerve-related pain, can cause fluid retention that results in swelling of the legs and feet.

This swelling closely resembles a hallmark symptom of heart failure, prompting many doctors to prescribe additional treatments like diuretics. These unnecessary medications can expose patients to complications including kidney damage, dizziness, and fall-related injuries, according to findings published in JAMA Network Open.

Dr. Michael Steinman of the University of CaliforniaSan Francisco noted that although gabapentinoids are seen as safer alternatives to opioids, regular consultations are essential to ensure they remain the most suitable option. He emphasized that patients might benefit from alternative treatments, including non-pharmacological approaches.

The study highlights that prescriptions for gabapentinoids have surged significantly over the past decade. To assess their impact, researchers analyzed medical records from 120 veterans with an average age of 74, all of whom were taking multiple long-term medications.

Every participant had been prescribed gabapentinoids and subsequently developed leg and foot swelling. Yet, only four physicians considered the drugs as the potential source of the symptom. Sixty-nine attributed the swelling to unrelated medical issues, most commonly heart failure. Another frequently cited cause was venous stasis, a condition involving impaired blood flow and increased vein pressure.

All involved physicians prescribed diuretics to address the swelling, even those who suspected gabapentinoids might be responsible. Within two months of starting diuretics, nearly a quarter of the patients experienced side effects including worsening kidney function, dizziness, blurred vision, and electrolyte imbalances. Six individuals required emergency treatment or hospitalization.

Researchers identified this pattern as a "prescribing cascade," in which new medications are used to treat side effects created by previously prescribed drugs. Only one clinician advised stopping gabapentinoids after swelling developed.

Additionally, about one in five patients underwent imaging procedures to exclude other serious health concerns as the source of the swelling. Dr. Matthew Growdon, also of UCSF, emphasized that gabapentinoids are sometimes given at unnecessarily high doses or for conditions they do not effectively treat. He advised clinicians to reconsider prescribing them or to opt for lower doses to reduce the risk of cascading prescriptions and adverse reactions.

Author: Aiden Foster