Concerns With Administration Times For Multiple Medications

In our latest question and answer, the pharmacist provides suggestions on how to take multiple medications during the day.

Question

Hello, I'm currently taking levothyroxine, Ursodiol, Vitamin D, and Benadryl. I'm adding Gabapentin 3x300mg and Cymbalta 30mg. I used to take Levo, Urso, and Vitamin D in the morning, and Benadryl at night. Should I take the Cymbalta and Gabapentin in the morning with the rest, or stagger them? The Gabapentin makes me feel cottony-headed; will that go away? With my liver issues from primary biliary cholangitis, are there any red flags I should be aware of with these meds? Thank you!

Asked by Clicky On Apr 14, 2024

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Apr 16, 2024
Last updated May 20, 2024

Answer

Thanks for getting in touch!

Let's organize the medications you mentioned:

  • Ursodiol
  • Vitamin D
  • Benadryl
  • Gabapentin
  • Cymbalta
  • Levothyroxine

There don't seem to be any major issues or "red flags" with taking these medications together.

If you were to check these medications using an online interaction checker, you might see some minor interactions reported, such as an increased risk of dizziness or drowsiness from gabapentin and Benadryl. Overall, though, there's nothing major in terms of interactions.

However, there are some timing considerations to keep in mind.

Timing Considerations

Some of these drugs have considerations we have to take into account.

For example, unless you've been instructed otherwise, levothyroxine should generally be taken on an empty stomach, at least 30 minutes before food or other medications. Its absorption can be affected by even minor changes, so it's important to take it correctly.

For Cymbalta and gabapentin, they can usually be taken together as they don't interact. The drowsiness or 'fog' you're experiencing with gabapentin is common and often improves over time. It's often recommended to start at a low dose and increase gradually to reduce the risk of this side effect occurring.

Other considerations include the drowsiness Benadryl causes, and the fact that Vitamin D and ursodiol are generally recommended to be taken with food.

Example Schedule

Here's a sample schedule I put together, but remember to follow your doctor's advice for your specific situation. Don't make any medication changes without consulting them first.

  • Levothyroxine: Morning, 30-60 minutes before food or other medications
  • Ursodiol: With food or milk, so take it with breakfast
  • Vitamin D: With a meal containing some fat, so take it with breakfast
  • Cymbalta: Can be taken at any time, but morning is best for most people due to the potential side effect of insomnia
  • Gabapentin: Follow your instructions, taken with or without food
  • Benadryl: Take it in the evening as needed

This schedule is a general recommendation based on timing considerations. Again, always consult your doctor before making any changes.

Final Thoughts

I hope this information helps! If you have more questions, feel free to ask.

Thanks once again for reaching out!

References

  • Synthroid Prescribing Information, AccessFDA
  • Cymbalta Prescribing Information, AccessFDA
  • Gabapentin Prescribing Information, AccessFDA

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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