Author: Charles Frank

Taking Gabapentin With Opioids for Acute Conditions Increases Risk of Opioid-Use Disorder

Health care professionals should educate patients that it is possible to effectively manage pain without opioids. Call your doctor immediately if you experience a fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, or yellowing of the skin or the whites of your eyes. If your doctor does prescribe these medications together, you may need a dose adjustment or special tests to safely take both medications. However, the potential risk of severe side effects makes this combination generally ill-advised.

Traditionally, gabapentin and other non-opioid-type medications were used for long-term chronic pain conditions, including anxiety, seizures, shingles, and diabetic neuropathy, as opposed to opioids, which were prescribed for short-term pain relief in acute situations, such as post-operative, according to Little. While opioids play a crucial role in managing severe pain, they must be used responsibly due to their high potential for abuse and addiction. When misused, opioids can lead to harmful side effects, addiction, overdose, and even death.

S1 Fig. Kaplan–Meier survival curves for Cohort 1.

The heightened risk of fatal overdose makes this an exceptionally dangerous combination. Dr Gomes said she is “not aware of guidelines that have made specific recommendations around the combined use of these products. In fact, it is likely that clinicians have chosen to use these two drugs together to treat chronic pain in an attempt to avoid using high doses of opioids in their patients.” “Despite these potential risks, so far no studies have examined whether the concomitant use of gabapentin and opioids really increases the likelihood of accidental opioid-related death and whether this risk is gabapentin dose dependent,” they write. In our exploratory analysis of patients at risk of combined opioid and gabapentin use, we found a total of 98,288 gabapentin users in calendar year 2013, of whom 45,173 (46.0%) received at least 1 concomitant prescription for an opioid.

Fig 1. Inclusion/exclusion criteria applied to cases and controls.

A pharmacokinetic interaction most likely reflects increased gabapentin absorption, which occurs primarily in the upper small intestine 5. Thus, opioid-induced slowing of gastrointestinal transit could prolong the time spent within this narrow absorption window and increase gabapentin bioavailability 5. First-line antidepressants recommended for the treatment of peripheral or central NP include tricyclic antidepressants (TCA) (amitriptyline and nortriptyline) and serotonin-noradrenaline reuptake inhibitors (SNRI) (duloxetine and venlafaxine) 7,20,21.

1. The risk of side effects is still a substantial limiting factor, with a lack of clear safety and efficacy data and substantial risk for adverse events in specific NP populations.
2. This combination can lead to excessive sleepiness, slowed reflexes, and impaired cognitive function.
3. However, persistent, chronic pain becomes pathological and imposes substantial clinical, psychological, social, and financial burdens on society.
4. Neuropathic pain (NP), which arises from a disease or lesion of the somatosensory nervous system 1,3, represents a substantial proportion of chronic pain, with nearly one quarter of those with chronic pain and up to 10% of the global population experiencing chronic NP 4.

Drug and food interactions

It belongs to the class of drugs known as anticonvulsants or antiepileptics, which work by reducing unusual brain activity that leads to seizures. This makes it a key player in the medical field, especially when it comes to neurological disorders. If you already have a headache and navigate your way to the pain relief shelf at your pharmacy the headache is likely to get worse. To investigate, the researchers used an administrative healthcare database to identify 1256 residents of Ontario whose cause of death was related to opioid use. The investigators matched each of these persons with up to four control persons who also used opioids (4619 control participants). NP is considered a distinct clinical entity, comprised of many syndromes which create a heterogenous group.

Does Alvogen oxycodone work as well as brand name Percocet for chronic pain?

Collectively, approximately half of patients with NP are reported to receive at least two analgesic drugs for pain management 62,63,64. However, preclinical and clinical data describing the safety and efficacy of combination therapies are inconsistent 83,84. Ongoing programs for combination therapy regimens for NP management aim to identify drug combinations with both improved analgesic efficacy and improved tolerability/reduced risk for side effects. Preclinical and clinical trial data on the efficacy and safety of specific combination therapy regimens evaluated for chronic NP management are summarized below and in Table 1. Chronic neuropathic pain (NP) is an increasingly prevalent disease and leading cause of disability which is challenging to treat. Several distinct classes of drugs are currently used for the treatment of chronic NP, but each drug targets only narrow components of the underlying pathophysiological mechanisms, bears limited efficacy, and comes with dose-limiting side effects.

Almansa and colleagues were the first to report the development of co-crystals containing rac-tramadol hydrochloride and celecoxib and demonstrate synergistic efficacy in vivo 145,146. As described previously in this review, tramadol and celecoxib represent distinct drug classes with complementary mechanisms targeting multiple central and peripheral NP pathways, with celecoxib being suggested to have improved cardiovascular safety relative to other NSAIDs 147,148. The co-crystal, called Seglentis® has been evaluated for the treatment of acute postoperative pain. In this context, it exhibited an improved pharmacokinetic profile, with a faster intrinsic dissolution rate of celecoxib relative to celecoxib alone and a slower intrinsic dissolution rate of tramadol relative to tramadol alone 145,146. The lower peak concentration of tramadol and faster analgesic onset of celecoxib in the co-crystal is an advantage over combination therapy of the two agents as it could convey a substantially improved risk/benefit ratio. Consistently, the co-crystal was more effective than the single drugs, and more effective than the theoretically calculated additive benefit of the two drugs, in reducing acute postoperative pain without potentiating the risk for adverse effects 145,146,149.

Study design and data source

At the heart of this interaction is the cumulative sedative effect that both drugs have on the CNS. Gabapentin, by its very nature, is a CNS depressant, reducing abnormal brain activity, which can lead to drowsiness and dizziness. Opioids, on the other hand, not only provide potent pain relief but also produce sedative effects, leading to drowsiness, mental fog, and slowed breathing. When combined, these drugs can significantly increase these sedative effects, leading to heightened drowsiness, confusion, and even loss of consciousness. And many are also unaware that some of these drugs can be combined while others cannot. First, let’s look at the four drugs that are available OTC in the US and some alternate names they are known by.

There are several alternatives, such as non-opioid pain relievers and certain antidepressants. Long-term use can lead to changes in the brain that result in opioid use disorder (OUD), a type of substance use disorder characterized by loss of control over opioid use, compulsive use, and continued use despite harm or negative consequences. Swelling in the hands, ankles, or feet, unexplained weight gain, and pain in the eyes or visual changes are among the potential physical manifestations. These should not be ignored and should prompt immediate consultation with a healthcare provider. It’s also been found to be effective in managing certain types of nerve pain, particularly postherpetic neuralgia (nerve pain following shingles) and peripheral neuropathy (nerve damage from causes such as diabetes or injury).

While data sharing agreements prohibit ICES from publicly releasing a minimal deidentified dataset, access can be granted to those who meet pre-specified criteria for confidential access through the Data & Analytics Service (DAS). To view an interaction report containing 4 (or more) medications, please sign in or create an account. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Symptoms can include rash, itching, or swelling (especially of the face, tongue, or throat), severe dizziness, and difficulty breathing. Then after a while they switched me to Tramadol because it’s a preferred treatment for neuropathy, so now I take Gabapentin and Tramadol together without any issues. Yes I’ve taken Gabapentin and oxycodone together and it’s fine, just be aware that they can knock you out so it’s good to increase the Gabapentin gradually.

Each opioid presents unique risks when combined with Gabapentin due to its specific pharmacological profiles. While Gabapentin is often well-tolerated and can provide significant benefits for those suffering from specific conditions, it is crucial to be aware of potential side effects. These can vary in intensity and frequency among different individuals, depending largely on factors such as dosage, duration of use, individual physiology, and the use of other medications.