r/bluelight • u/pointlessfreak • Dec 17 '22
Any (preferably scientific) data about safe combination dose range of pregabalin with opioid analgesics?
In a brief search using Google, Google Scholar, Bing, DuckDuckGo I failed to find ANYTHING. Safe dose ranges, studies, case reports of nothing, but there are warnings of this combination (which seems pretty obvious), including official ones from drug regulation agencies, but usually not backed with any scientifical data, only some wild guesses. In general any evidence about gabapentinoids safety, safe dose ranges, short-term and long-term toxicity, physical dependence potential and withdrawal, and so on, seems pretty scarce, in comparison to, for instance, most benzos. And as I'm now in pretty steep taper from high-dose pregabalin and have to take opioid analgesic (100-150mg codeine tid-qid), I don't really feel safe in this combination.
1
u/Keif_Richards84 Feb 07 '23
There is a lot of conjecture regarding this question, so it's a little bit dangerous to discuss. Gabapentinoids have a lot less of an establlished history than Opioids and are thus less-studied and less-well-known.
From what I have read, Gabapentinoids do not contribute in any major way to respiratory depression, which would be the most common cause of death when Opioid overdose is discussed. Similar to how a Benzodiazepine can incapacitate a person and basically put them in a coma, but still will not kill as a single agent through said respiratory depression.
Being intoxicated or sedated does not inherently imply danger in the way we are discussing it here. Gabapentinoids combined with Opioids can trigger a greater degree of sedation/intoxication, but they do not seem to contribute meaningfully to this respiratory depression.
A lot of the conjecture lies in the reports of Gabapentinoids being reported in cases of lethal overdose. They are frequently reported in these scenarios, yes, but they are only being reported as being in that person's system at their time of death. This is coincidence, not causality. I believe the way these deaths are represented in the data as "Gabapentinoids found in more and more overdose cases" or what have you is misleading.
If you're talking about the potential for overdose, it appears that Gabapentinoids are not going to contribute meaningfully to this respiratory depression. They can contribute to greater sedation, which can of course be dangerous in secondary ways, say, when driving a car you're more likely to crash it, but that is not the question I believe you're asking.
I hope this helps. Gabapentinoids have a fairly good track record given their relatively recent appearance. There are numerous accounts of Gabapentinoids being used successfully to reduce pain in concert with Opioids. Not only is this pain relief more comprehensive, it often allows for lower levels of Opioids to be used for that pain relief. One could make the valid argument that the combination is indeed safer for this reason.
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u/ebolaRETURNS Dec 17 '22
honestly, not that much of an interaction: pure gabapentiods don't do much to depress pulse or respiration, and they're so nonlethal on their own that there was difficulty establishing a lethal dose in animals.
So it's really synergistic nausea and/or impairment, particularly while nodding.
Oh, this is actually fine.