Major
Gabapentin with opioids: serious breathing difficulties
With: Other opioids (morphine, fentanyl, methadone, oxycodone, hydromorphone, tramadol) Opioid
Why it happens
Gabapentinoids depress respiratory drive; opioids do the same. The combined effect is greater than either alone.
What can happen
FDA warns of serious breathing difficulties, including respiratory depression, when gabapentinoids are combined with opioids, and of increased risk of death. Elderly patients and those with lung or kidney disease are at higher risk.
What to do
Use the lowest effective gabapentin dose, watch closely for sedation and slow breathing, and tell the prescriber about any breathing condition.
Basis: FDA Drug Safety Communication: Serious breathing difficulties with gabapentinoids (2021); gabapentin prescribing information. source
Why it happens
Combined central nervous system depression.
What can happen
Sedation, dizziness, and impaired coordination. FDA advises against alcohol with gabapentinoids.
What to do
Avoid alcohol while taking gabapentin.
Basis: Gabapentin prescribing information, Warnings and Precautions. source
Moderate
Gabapentin with other CNS depressants: additive sedation
With: Other CNS depressants (opioids, benzodiazepines, sleep aids, sedating antihistamines, gabapentinoids, muscle relaxants) CNS depressant
Why it happens
Gabapentin potentiates the sedative effect of alcohol, opioids, and other depressants.
What can happen
Excessive sedation, dizziness, and impaired coordination, with respiratory depression risk in combination.
What to do
Avoid alcohol. Review all sedating medications with the prescriber or pharmacist.
Basis: Gabapentin prescribing information, Warnings and Precautions. source