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Gabapentin, like any other substance, can interact with other substances. Those taking gabapentin should therefore always disclose to their doctors any medical conditions, other medications (prescription or over the counter), supplements, herbal products, illicit drugs, tobacco products, alcoholic beverages, and dietary choices. This way, their doctors can better evaluate the risk of interactions.

Drug Interactions

According to the U.S. National Library of Medicine, the following drug interactions may occur:

  • Opioids (like hydrocodone and morphine)
  • Maalox (aluminum hydroxide, magnesium hydroxide)

*Note that this list is NOT complete, and other drug interactions may occur. Always talk with your doctor about any and all drugs (prescription and over the counter) drugs you take before taking gabapentin.

Opioids

The concomitant use of gabapentin and opioids “was associated with a substantial increase in the risk of opioid-related death,” according to one 2017 study. Therefore, patients should talk to their doctor about any opioid use—both legal and illegal—before taking gabapentin.

Hydrocodone (Hysingla)

Hydrocodone is an opioid used for long-term treatment of severe pain. Research suggests that gabapentin could affect hydrocodone exposure. This interaction doesn’t necessarily mean that patients cannot take the two drugs together, simply that extra precautions should be taken, especially in consideration to dosage.

Morphine (MorphaBond ER, Arymo ER, Infumorph P/F, Astramorph-PF, Duramorph, MS Contin)

Morphine is another opioid that may interact with gabapentin. Specifically, it may increase the risk of central nervous system (CNS) depression. Signs of CNS depression include:

  • Excessive sleepiness (somnolence)
  • Ineffective and slow breathing (hypoventilation/respiratory distress)

Doctors should therefore closely monitor patients taking morphine and gabapentin concurrently for signs of CNS depression.

Maalox (aluminum hydroxide, magnesium hydroxide)

The antacid Maalox can reduce the bioavailability of gabapentin by roughly 20%. Experts therefore recommend taking gabapentin at least 2 hours after Maalox to ensure maximum bioavailability.

Gabapentin and Adderall

Adderall is a combination of four different kinds of amphetamines used to treat conditions like ADHD. This drug interaction can alter seizure threshold for patients. However, patients taking Adderall should still disclose this fact to their doctors before taking gabapentin.

Gabapentin and Tramadol

Tramadol (Ultram) is a narcotic used for the short-term treatment of moderate to severe pain. Combining the two drugs can result in a synergistic effect, leading to greater depression of the CNS. Therefore, patients taking tramadol should disclose this information to their physicians before taking gabapentin.

There is some limited research that suggests smaller doses of both tramadol and gabapentin together can produce desirable pain-relieving effects. For example, one 2011 study examined post-surgery use of tramadol with gabapentin for the treatment of certain kinds of pain in rats; results concluded that these two drugs can be somewhat effective in reducing the pain of heat hyperalgesia (intense sensitivity to heat). Another 2005 study also found that combining these drugs produced desirable pain-relieving results.

More research, however, is needed to determine the effectiveness and safety of concomitant use of these drugs in humans.

Disease Interactions

Doctors should take special consideration in regards to dosing gabapentin in patients with the following:

  • Renal (kidney) dysfunction and hemodialysis (kidney dialysis)
  • Suicidal tendencies
  • Myasthenia gravis (muscle weakness and fatigue, resulting in droopy facial features)
  • Respiratory disease
  • Seizure disorder
  • Substance abuse

Note that this list may not be complete, and other interactions may occur.

Renal Dysfunction and Hemodialysis

Because the body primarily excretes gabapentin via the kidneys through the urine, those with some sort of kidney dysfunction or undergoing dialysis should have their gabapentin dosage adjusted.

Suicidal Tendencies

Reports indicate that gabapentin may increase the risk of suicidal tendencies in patients. Physicians should therefore closely monitor their patients for signs of new or worsening suicidal tendencies. Any thoughts or actions of suicide should be reported to a physician and/or met with medical attention.

Alcohol Interactions

For more information, please visit our page about alcohol and gabapentin interactions.

Note that this list may not be complete, and other interactions may occur.

Disclaimer: this article does not constitute or replace medical advice. If you have an emergency or a serious medical question, please contact a medical professional or call 911 immediately. To see our full medical disclaimer, visit our Terms of Use page.


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