Can You Take Gabapentin And Codeine Together?
In our latest question and answer, the pharmacist discusses whether or not gabapentin can safely be taken with codeine.
Can you take gabapentin and codeine at the same time?
Nov 09, 2022- Both gabapentin and codeine are central nervous system depressants, so taking them together increases your risk of serious side effects like difficulty breathing and excessive drowsiness. If your doctor determines this combination is necessary for your pain, use the lowest possible doses for the shortest time needed and watch carefully for any signs of slowed breathing or severe sedation. Always discuss with your doctor before taking these medications together, as other treatment options may be safer.
Answer
Gabapentin and codeine should be used cautiously together as both are considered CNS (central nervous system) depressants, and combining them can put you at an increased risk of side effects.
There certainly are situations where taking both of these drugs may represent the best course of therapy for you, but it is important to be aware of the risks.
What Are The Risks?
As mentioned, both codeine (an opioid agonist) and gabapentin are CNS depressants. Combining them puts you at a greater risk of side effects, especially serious side effects like respiratory depression.
The FDA has even released a safety communication regarding combining CNS depressants, and includes gabapentin in the warning:
The U.S. Food and Drug Administration (FDA) is warning that serious breathing difficulties may occur in patients using gabapentin (Neurontin, Gralise, Horizant) or pregabalin (Lyrica, Lyrica CR) who have respiratory risk factors. These include the use of opioid pain medicines and other drugs that depress the central nervous system, and conditions such as chronic obstructive pulmonary disease (COPD) that reduce lung function. The elderly are also at higher risk.
The FDA made this announcement as studies have shown that combining opioids and gabapentin increases the risk of opioid-induced deaths. One such study concluded:
In this study we found that among patients receiving prescription opioids, concomitant treatment with gabapentin was associated with a substantial increase in the risk of opioid-related death. Clinicians should consider carefully whether to continue prescribing this combination of products and, when the combination is deemed necessary, should closely monitor their patients and adjust opioid dose accordingly.
Managing The Interaction
As a general rule of thumb, drugs like gabapentin and codeine should only be combined if you and your doctor determine that is the best course of therapy and other treatment options are inadequate.
If they are used together, it is important to use the lowest dosages and the shortest duration of therapy possible. It is also important to be on the lookout for any concerning side effects, such as slowed or difficult breathing and/or excess sedation.
Final Words
Thanks for reaching out to us! I hope you found this helpful.
I do want to say that although this combination of medication needs to be used very cautiously, it's not uncommon that both are used in certain patients. Pain can be extremely difficult to manage, and oftentimes, it requires drugs that have inherent dangers to them.
The important thing is to be aware of the risks, and what to look out for.
References & sources
- Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study — PubMed
- FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR) — FDA
- Gabapentin Monograph — PubChem
Glossary — Terms in This Answer
- CNS depressants
- Drugs that slow down brain and nervous system activity, reducing alertness and breathing rate.
- Opioid agonist
- A medication that binds to opioid receptors in the body to produce pain relief and other effects.
- Respiratory depression
- A serious condition where breathing becomes dangerously slow or shallow.
- FDA
- The U.S. Food and Drug Administration, the government agency responsible for approving and monitoring the safety of medications.
- Chronic obstructive pulmonary disease (COPD)
- A long-term lung disease that makes it difficult to breathe and reduces how much air can move in and out of the lungs.
- Opioid-induced deaths
- Deaths caused by opioid medications, often involving serious side effects like stopped breathing.
- Concomitant treatment
- Taking two or more medications at the same time.
- Sedation
- A state of reduced consciousness or drowsiness caused by medication.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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