Question: My question is regarding my dad who is 76 yrs old . He had CABG surgery on XXXXXXX 21st and two days post op he suffered a stroke. His recovery was complicated and included 3 weeks intubation. Mediastinitis and an 8 week course of Vancomycin I/v. He spent a month in ICU. Was treated for hypotension initially post op and tachycardia. Was started on Metoprolol which he had never taken before. To give a bit of background hx had been a very active person but was diabetic and had been on oral meds for several yrs then insulin was started last yr. He had been taking Lipitor for cholesterol and lisinopril . Has a strong family hx of heart disease. Anyway he improved and after 3 months was transferred to a rehab facility. He had severe rt sided weakness and aphasia. Before transfer to his blood pressure was usually less than 100 systolic. He was being transferred to chair via a mechanical lift. I should mention that he went into atrial fib post op which was why the metoprolol was started. Since being at the rehab facility he's improved in a short time with regards to his ADL'. He's eating and drinking well. He's continent. He's one person pivot to the chair and has all muscles working in his rt leg. His rt arm no movement. Since he started physio he's experienced several episodes of severe hypotension. Ie 60/40. Shortly after this he was started on Gabapentin for pain in his rt arm. His shoulder is dislocated. His metoprolol was decreased from 125mg bid to 50mg bid and his Lisinopril from 10mg bid to 7.5mg bid. His gabapentin dose was increased to 300mg tid. His low hypotensive episodes occurred more frequently .almost daily and sometimes twice daily especially when up in chair or having therapy. One reading was 56/41! Our family noticed increased urination, drowsiness, decreased strength and balance when ambulating. Initially it seemed to help his pain but later seemed to be ineffective. The dr caring for him said given his heart disease there is no other drug except gabapentin for his pain. The hypotension she seems to attribute to the stroke and she's reluctant to reduce or certainly discontinue the meds. I'd appreciate any feedback. I apologize for the long note but I'm desperate for any advice.

The information you've given isn't really helpful. I'm a nurse myself so I know things that can cause hypotension. He IS eating and drinking well. My concern is that the Gabapentin is contributing to the hypotension and I wonder if there is an alternative given his heart condition.

Thank you. I will check with his dr re this alternative