5 Gabapentin Interactions You Should Know About

GoodRx Health

Gabapentin (Neurontin) is an anticonvulsant (antiseizure) medication that's FDA approved to treat seizures and post-herpetic neuralgia (nerve pain from shingles). It's also considered a first-choice treatment option for general nerve pain. But this is an off-label use.

Gabapentin is also available as Gralise, an extended-release (ER) formulation. It's approved for post-herpetic neuralgia. Another ER formulation (Horizant) is FDA approved for post-herpetic neuralgia and restless leg syndrome.

Though gabapentin has many uses, it can interact with other medications. Some gabapentin interactions may worsen the side effects of gabapentin, like dizziness and sleepiness. Others may make gabapentin less effective.

1. Opioids like oxycodone, hydrocodone, and tramadol

Opioids are a group of medications that treat pain. Examples include oxycodone (Oxycontin, Roxicodone), hydrocodone (Hysingla ER), and tramadol (Conzip, Qdolo).

Gabapentin and opioids share some side effects. They can both cause tiredness and slow your breathing. Combining opioids with gabapentin makes these side effects more likely. Gabapentin can also increase the "high" that some people experience with opioids. And some research shows that taking gabapentin with opioids increases the risk of opioid-related deaths, including death from opioid overdose.

What's more, opioids are controlled substances, and gabapentin is also considered a controlled substance in some states. Controlled substances have a greater risk for dependence and addiction. Research shows that people who misuse opioids are more at risk for misusing gabapentin. This is why it's especially important to take gabapentin (and opioids) only as prescribed. It lowers your risk of misuse, side effects, and overdose.

In general, it's best to avoid combining opioids and gabapentin. However, if your prescriber believes you need this combination, talk to them about how to minimize your risk. And watch for side effects, like extreme sleepiness and trouble breathing. Seek immediate medical care if you experience these symptoms.

Good to know: If you're experiencing aches and pains while taking gabapentin, opioids aren't your only source of relief. In fact, they're usually not a first-choice option for pain. Over-the-counter (OTC) painkillers may be a better choice, such as acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve). These medications aren't known to interact with gabapentin.

2. Antihistamines like Benadryl

Antihistamines treat many medical conditions. They can help with trouble sleeping, allergies, and itching. They work by blocking histamine. Histamine is a chemical that's involved in many processes in the body, such as regulating sleep. Examples of antihistamines include:

• Hydroxyzine pamoate (Vistaril)

• Loratadine (Claritin, Alavert)

• Doxylamine (Unisom SleepTabs)

• Diphenhydramine (Benadryl)

Some antihistamines, like Benadryl, Unisom SleepTabs, and Vistaril are sedating. So they can interact with gabapentin by causing too much sedation. Others, like loratadine, aren't known to cause much sleepiness and probably won't interact with gabapentin.

Before you take gabapentin, talk to your prescriber. Give them a list of all the medications you take, even those that are OTC. And if you need an antihistamine while taking gabapentin, your pharmacist or prescriber can help you pick one that's less likely to interact.

3. Benzodiazepines like Xanax, and other sedatives

Sedatives are a broad group of medications. They treat sleep problems, anxiety, and more. Examples of these prescription-only medications include:

• Benzodiazepines, like lorazepam (Ativan) and alprazolam (Xanax)

• Sleep medications, like zolpidem (Ambien, Edluar, and ZolpiMist) and eszopiclone (Lunesta)

• Barbiturates like phenobarbital

Sedatives can have a variety of side effects. They may cause poor coordination, dizziness, and sleepiness. Gabapentin can cause these side effects, too. So it may be best to avoid taking it if you already take a sedative.

Other medications with sedative-like effects come with similar risks. These include muscle relaxers, such as cyclobenzaprine (Amrix), methocarbamol, and baclofen. If you take these, it's a good idea to talk to your prescriber and pharmacist before starting gabapentin. They can let you know if any medications you take could cause sedation.

If your prescriber thinks you need a sedative and gabapentin, you may need lower doses of one or both medications.

4. Alcohol

Alcohol affects many organs in the body, including the brain. It can impact your mood and decrease your alertness. In severe situations, it can even slow down your breathing.

Alcohol is known to interact with many medications, including gabapentin. Drinking alcohol while taking gabapentin can raise your risk of sleepiness and dizziness. So it may be best to avoid alcohol if you have a gabapentin prescription.

Let your prescriber know if you drink alcohol before starting gabapentin. They can help you decide if gabapentin is a safe option for you.

Some prescribers may recommend gabapentin to help treat alcohol use disorder. It's not FDA approved for this reason, but it has been shown to help people stay away from alcohol.

5. Antacids and other medications that contain magnesium or aluminum

Magnesium is a part of many multivitamins. It's also a part of some antacids, which help relieve symptoms of heartburn. Examples include Mylanta Maximum Strength (aluminum hydroxide / magnesium hydroxide / simethicone) and Rolaids (calcium carbonate / magnesium hydroxide).

Magnesium and medications containing aluminum can lower gabapentin levels in the blood. This means that usual doses of gabapentin may not be as effective. It's a good idea to wait at least 2 hours after taking a medication containing aluminum or magnesium before taking a dose of gabapentin.

Does gabapentin interact with cannabis?

Gabapentin and cannabis can cause similar side effects, such as dizziness and drowsiness. So taking them together can worsen these effects. Although cannabis is sometimes used for nerve pain, it's not an FDA-approved medication.

It's best to avoid combining gabapentin and cannabis unless you've discussed it with a healthcare professional. They can make recommendations about what cannabis products and dosages may be best for you.

When should I contact my healthcare team about a gabapentin interaction?

Always talk to your prescriber and pharmacist before starting gabapentin. Give them an up-to-date medication list. Include both prescription and OTC medications, as well as supplements. This can help them check for gabapentin interactions. And if you drink alcohol, make sure to let your prescriber know before starting gabapentin.

If you're experiencing signs of a gabapentin interaction, let your prescriber know right away. This may include excessive sleepiness or dizziness. If the symptoms are severe, such as slowed breathing or confusion, seek immediate medical care. These symptoms can be life-threatening.

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