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.
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!
Apr 14, 2024- Levothyroxine should be taken on an empty stomach, at least 30 minutes before food or other medications, because its absorption can be affected by even minor changes. Vitamin D and ursodiol are best taken with food, while Cymbalta and gabapentin can be taken together without major interaction concerns. Drowsiness from gabapentin is common and often improves over time, especially when started at a low dose and increased gradually.
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 & sources
Glossary — Terms in This Answer
- Ursodiol
- A medication that helps dissolve gallstones and is typically taken with food to improve absorption.
- Levothyroxine
- A synthetic thyroid hormone used to treat an underactive thyroid gland.
- Gabapentin
- A medication used to treat nerve pain and certain types of seizures.
- Cymbalta
- An antidepressant medication that also helps treat chronic pain and anxiety disorders.
- Benadryl
- An over-the-counter antihistamine commonly used to relieve allergy symptoms and help with sleep.
- Absorption
- The process by which a medication is taken into the body through the digestive system and enters the bloodstream.
- Interaction
- When two or more medications affect each other in the body, potentially changing how they work or increasing side effects.
- Insomnia
- A sleep disorder where a person has difficulty falling asleep or staying asleep.
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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