Gabapentinoids/Opioids (IR & ER) Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Opioids slow down your GI tract. This may allow your body to absorb more gabapentin and pregabalin. Gabapentin and pregabalin may change how your body reacts to opioids.

What might happen:

The amount of gabapentin or pregabalin in your blood may increase and cause more side effects than expected.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Let your doctor know about all the medicines you take and if you have problems with your kidneys or lungs. Let your doctor know if you experience severe drowsiness. Your doctor may need to adjust the dose of your medicines.Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, give them naloxone if available, then call 911. If the person is awake and has no symptoms, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, slow heartbeat, coma.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

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  • 2.FDA (US Food and Drug Administration). FDA MedWatch Safety Alert: FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica). Available at: https://www.fda.gov/drugs/drug-safety-and-availability Dec19, 2019.
  • 3.Hill R, Dewey WL, Kelly E, Henderson G. Oxycodone-induced tolerance to respiratory depression: reversal by ethanol, pregabalin and protein kinase C inhibition. Br J Pharmacol 2018 Jun;175(12):2492-2503.
  • 4.Gomes T, Juurlink DN, Antoniou T, Mamdani MM, Paterson JM, van den Brink W. Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study. PLoS Med 2017 Oct; 14(10):e1002396.
  • 5.Neurontin (gabapentin) US prescribing information. Pfizer, Inc. September, 2015.
  • 6.Gralise (gabapentin) US prescribing information. Abbott Laboratories August, 2012.
  • 7.Health Canada. Health Canada MedEffect e-Notice: Health Canada advises Canadians to exercise caution when taking gabapentin or pregabalin with opioids. available at: https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2019/71003a-e ng.php Sept 17, 2019.
  • 8.USFood and Drug Administration. FDA Drug Safety Communication: FDA recommends health care professionals discuss naloxone with all patients when prescribing opioid pain relievers or medicines to treat opioid use disorder. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-heal th-care-professionals-discuss-naloxone-all-patients-when-prescribing-opioi d-pain July 23, 2020.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.