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Key takeaways
Gabapentin and hydrocodone are not usually prescribed at the same time by medical professionals, because of risks of excessive drowsiness, confusion, and respiratory depression.
However, in some circumstances, a doctor might prescribe them together, such as in cases of severe nerve pain or other severe pain.
If you are taking gabapentin and hydrocodone together, follow the dosing and dosing schedule of your healthcare provider and be aware of your side effects.
Gabapentin (brand-names Neurontin and Gralise) is an anti-seizure medication that can also be used as a muscle relaxant and anti-spasmodic medication. It’s FDA approved to treat postherpetic neuralgia pain (a common complication of shingles) and to manage seizures in adults and children aged 3 and up. Gabapentin is also used off-label to manage other types of neurological pain and to treat psychiatric disorders, such as severe panic disorder and social anxiety disorder.
Hydrocodone, sold under the brand names Vicodin, Norco, and Lortab, is an opioid medication that’s FDA-approved for pain management. It’s usually used to treat severe causes of pain that aren’t effectively treated with other types of pain relievers. Hydrocodone is a Schedule II drug, which means it has a high potential for addiction and abuse.
It’s common to wonder if these two pain medications can be taken together. You might be wondering: Can I take hydrocodone with gabapentin? While it’s possible to take these two medications together, most physicians don’t recommend combining gabapentin with hydrocodone because of the risk of dangerous side effects like serious sedation, respiratory depression, confusion, and breathing issues.
Here, we’ll examine the question, “Can you take gabapentin with hydrocodone?” We’ll explore how these medications interact with each other, the risks of taking them together, any potential benefits, and safer alternatives to combining gabapentin with hydrocodone.
Can you take gabapentin and hydrocodone together?
Both gabapentin and hydrocodone are medications commonly prescribed for pain management. Each medication works a little differently, with gabapentin used primarily for nerve-related pain and hydrocodone used for non-neuropathic pain, especially severe pain. The question is: Can you take hydrocodone and gabapentin together?
In general, these two medications are not prescribed together. “Combining gabapentin and hydrocodone can be risky because both can slow down your central nervous system, leading to excessive drowsiness or even respiratory issues,” explains Andrew Youssouf, MD, who is double board-certified in addiction medicine and emergency medicine and serves as medical director of Ikon Recovery. Whether gabapentin and hydrocodone are safe to take together depends on factors like dosage, drug tolerance, and overall health, he adds.
Claudia Cometa, Pharm.D., founder and CEO of Peace Advocacy Group agrees that it’s not usually safe to combine these two medications. The potential risks of combining them may be different depending on which condition you are aiming to treat. “For example, if an individual is taking gabapentin for seizure control and hydrocodone for pain, hydrocodone can lower the seizure threshold, meaning it can place the patient at a higher risk for seizures,” Dr. Cometa describes. “In addition, the higher the dosage of either medication, the greater the additive effects.”
However, there are exceptions, and there may be times when combining gabapentin and hydrocodone is appropriate. “It can be safe to take gabapentin and hydrocodone together, but it really depends on the specific situation,” says Taher Saifullah, MD, a pain management specialist and founder of Spine & Pain Institute Los Angeles.
When a healthcare provider prescribes these medications together, they have to carefully tailor the dosage and dosing schedule to the patient’s unique needs. “Safety often hinges on monitoring and adjusting based on how you respond to treatment, so communication with your doctor is key,” Dr. Saifullah emphasizes.
Benefits of taking gabapentin and hydrocodone at the same time
As Dr. Saifullah describes, combining gabapentin and hydrocodone may be a good choice for certain individuals, provided they are in good health, and will remain under the careful supervision of a healthcare professional. So why might you take gabapentin and hydrocodone together?
“One of the main advantages of combining gabapentin and hydrocodone is that they work through different mechanisms,” Dr. Saifullah explains. Gabapentin can aid in alleviating nerve pain and has the potential to enhance the pain-relieving effects of hydrocodone. This can allow you to use a lower dose of the opioid, and may be particularly helpful for people experiencing mixed pain types, Dr. Saifullah shares.
“Ultimately, this combination can lead to more effective pain relief, which means you can enjoy life more fully without being sidelined by discomfort,” says Dr. Saifullah. When the patient is on one medication and the pain is still unbearable, the second medicine may be started at a low dose and titrated up as the patient tolerates and as the pain decreases.
What are the drug interactions between gabapentin and hydrocodone?
The main issue with combining gabapentin and hydrocodone is that both of these medications have serious side effects, and when combined, the side effects can become magnified. “Due to the way these medications work in the central nervous system, the primary risk would be additive sedation and respiratory depression, or difficulty breathing,” explains Dr. Cometa.
Additionally, people who have seizure disorders should be wary. “Hydrocodone antagonizes the anti-seizure effects of gabapentin, placing the individual at an increased risk of seizures,” according to Dr. Cometa.
At times, the combination could be deadly. For instance, a 2017 observational study published in PLOS Medicine found that taking gabapentin with any opioid like hydrocodone is “associated with a substantial increase in the risk of opioid-related death.”
Dr. Youssouf notes the following individuals are at higher risk of adverse outcomes and serious side effects when taking gabapentin and hydrocodone together:
- Elderly patients
- People with breathing problems
- Individuals with underlying liver conditions
- People with kidney problems
- Patients who are opioid-naive
How long after taking gabapentin can you take hydrocodone?
If your healthcare provider recommends that you take gabapentin and hydrocodone together, they will likely start you on one medication at a time and also require that you space out your doses considerably so that there’s less risk of them interacting.
The timing of when you take these medications together is vitally important, says Dr. Youssouf. “Generally, it’s a good idea to wait a couple of hours after taking gabapentin before reaching for hydrocodone,” he says. It can be helpful to keep in mind that the half-life of gabapentin is five to seven hours. This is when half the dose of the medication is cleared from your body.
According to Dr. Youssouf, gabapentin typically peaks in your system around 2 to 3 hours after taking it. As such, your physician may recommend waiting those hours before taking hydrocodone. “By allowing this time, you can help reduce the risk of feeling overly sedated when combining these medications,” he says. “Always follow the dosing instructions given by your doctor, as they can provide the best guidance based on your specific situation.”
What medications should not be taken with gabapentin or hydrocodone?
Besides the question of how gabapentin or hydrocodone interact with one another, it can be helpful to consider what other medications you should steer clear of if you are taking either of these medications.
What medications should not be taken with gabapentin?
As Dr. Cometa notes, the most significant drug interaction to watch for with gabapentin is opioids, including hydrocodone. Additionally, the following medications should be used with caution:
- Antidepressants
- Sedatives
- Muscle relaxants
- Antihistamines
- Sleep aides
- Antacids
- Alcohol
- Antihypertensives
What medications should not be taken with hydrocodone?
The following medications should be used with caution if you are taking hydrocodone, according to Dr. Comesta:
- Other opioids
- Alcohol-based cough and cold syrups
- Anti-seizure medications (including gabapentin)
- Certain antifungal medications
It’s also important to understand the potential for substance abuse and addiction when you are taking hydrocodone.
What painkillers can be taken with gabapentin?
Although gabapentin and hydrocodone may be combined in certain situations, and under the close watch of a health professional, it’s usually best to combine gabapentin with other types of pain relievers, rather than opioids like hydrocodone.
According to Dr. Saifullah, if you are looking for safer options, consider taking acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. “They target pain through different mechanisms, so they can complement gabapentin’s effects without the added risks associated with opioids,” he says.
Even with these medications, it’s vital that you talk with your healthcare provider before combining pain medicine with gabapentin. “It’s always wise to check with your healthcare provider before adding any new medications to your routine,” Dr. Saifullah concludes.
Sources
- Gabapentin, StatPearls (2024)
- Psychiatric uses of gabapentin, Innovations in Clinical Neuroscience (2022)
- Hydrocodone, StatPearls (2024)
- Prescription of controlled substances: Benefits and risks, StatPearls (2023)
- Hydrocodone combination products, MedlinePlus (2024)
- Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study, PLOS Medicine (2017)
- Administration of four different doses of gabapentin reduces awakening from breakthrough pain and adverse effects in outpatients with neuropathic pain during the initial titration, Korean Journal of Anesthesiology (2013)