Can you take Gabapentin and Percocet together
What is Gabapentin
Gabapentin is a Generic name for an antiepileptic drug and anticonvulsant that is used to control certain types of seizures in patients with epilepsy. It works by affecting chemicals and nerves in the body that are the main cause of seizures and by decreasing abnormal neural excitation in the brain. This drug can be also used for the treatment of certain types of pain, such as nerve pain caused by herpes zoster virus also known as shingles (prolonged the stabbing and burning aches and pain that may last for months or years). Some of gabapentin indications are also: tremor, multiple sclerosis spasticity, mood disorders, and treatment of disruptive behaviors in dementia. Gabapentin is available in capsule and tablet dosage forms in the following strengths: 100, 300, 400, 600 and 800 mg and also in the form of solution 250 mg/5mL. Gabapentin is a very lipophilic drug; it isn’t metabolized by the liver, it doesn’t bind to proteins, and doesn’t have usual drug interactions.
Other common Brand names on the market containing gabapentin as an active ingredient are: Gralise, Horizant, Aclonium, Neurontin and Gabarone.
What is Percocet
Percocet is a Brand name for a drug containing a combination of acetaminophen and oxycodone as active ingredients. Oxycodone is an opioid narcotic drug that is used for pain relief while acetaminophen is a less potent pain reliever that is used to increase oxycodone effects. As a narcotic analgesic, oxycodone is more potent and addicting than its related compound codeine. Percocet is used for the treatment of moderate to severe pain. Each Percocet tablet contains oxycodone/acetaminophen combination, and tablets are available in the following strengths: 2.5/325 mg, 5/325 mg, 7.5/325 mg, 10/325 mg, 7.5/500 mg and 10/650 mg. Percocet dosage should be adjusted individually, according to the pain severity and the patient response. The dose can be exceeded in patients who have more severe pain or in those who become tolerant to the opioids analgesic effects.
Other products on the market containing oxycodone/acetaminophen combination are: Lynox, Magnacet, Narvox, Oxycet, Perloxx, Primlev, Roxicet, Taxadone, Tylox and Xolox.
How does Gabapentin and Percocet work in the body
Gabapentin works by interacting with cortical neurons and subunits of voltage-sensitive calcium channels. Gabapentin increases the synaptic amount of neurotransmitter GABA, improves responses to GABA at non-synaptic sites in neuronal tissues, and reduces the release of mono-amine neurotransmitters in the brain. One of the mechanisms implicated in this effect of gabapentin is lowering the threshold of the axon excitability in hippocampus by binding to presynaptic NMDA receptors. Other studies have shown that the antiallodynic and antihyperalgesic that can be used for the treatment of certain types of pain and also other effects of gabapentin are mediated by the descending noradrenergic system, resulting in the activation of spinal α 2-adrenergic receptors. Gabapentin has also been shown to bind and activate the A1 -adenosine receptor. Other neurophysiological studies have found that gabapentin can also interact with inflammatory cytokines and protein kinase C.
Oxycodone is a weak agonist of μ – mu, κ – kappa, and δ – delta opioid receptors within the CNS. Oxycodone predominantly affects μ opioid receptors, which are binded with G-protein receptors complex and acts as modulators, both negative and positive, of synaptic transmission through G-proteins that trigger effector proteins. Oxycodone decrease intracellular levels of cAMP by inhibiting enzyme called adenylate cyclase and release of nociceptive neurotransmitters such as GABA, dopamine, substance P, acetylcholine, and noradrenaline. Oxycodone can also inhibit hormone release of somatostatin, insulin, vasopressin, and glucagon. As κ -receptor agonist oxycodone closes N-type voltage-operated calcium channels, while as μ and δ receptor agonist, oxycodone opens calcium-dependent potassium channels. The results are hyperpolarization and reduced neuronal excitability.
Acetaminophen is highly selective COX-2 inhibitor that inhibits prostaglandin synthesis. It can inhibit COX-2 in CNS. Acetaminophen also acts on the hypothalamic heat regulating centers to produce antipyresis. Acetaminophen’s reactive metabolite N-acetyl-p-benzoquinone imine (NAPQI) can cause a potentially fatal, hepatic necrosis through the process of lipid peroxidation if acetaminophen is overdosed (more than 4g daily).
Can patients take Gabapentin and Percocet together?
Patients should not use Gabapentin and Percocet at the same time unless their doctors tell them otherwise. If these drugs are used together, they can cause serious side effects. Using Percocet together with gabapentin may increase side effects such as drowsiness, dizziness, difficulty concentrating, and confusion. Elderly patients may experience impairment in judgment, thinking, and motor coordination. If combination of these drugs is taken, patients mustn’t drive or operate machinery. By activating liver enzymes, Gabapentin can speed up Percocet metabolism. This may cause liver problems by increasing the levels of acetaminophens hepatotoxic metabolites.
The table below shows side effects after Gabapentin and Percocet administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.
|Very common side effects >10%|
|Dizziness (16-20%), Somnolence (16-20%), Drowsiness (5-21%), Ataxia (1-13%), Fatigue (11-15%)|
|Common and rare side effects 1-10%||Tremor (6-10%), Diplopia (6-10%), Nystagmus (6-10%), Hostility in children (5-8%), Back pain (1-5%), Depression (1-5%), Amblyopia (1-5%), Constipation (1-5%), Dysarthria (1-5%), Dyspepsia (1-5%), Dry mouth (1-5%), Pruritus (1-5%), Rhinitis (1-5%), Vasodilation (1-5%), Weight gain (1-5%), Hyperkinesia (3-5%), Increased appetite (1-5%), Leukopenia (1-5%), Myalgia (1-5%), Nervousness (1-5%), Peripheral edema (1-5%), Anorexia (>1%), Arthralgia (>1%), Asthenia (>1%), HTN (>1%), Pharyngitis (1-5%), Abnormal vision (>1%), Malaise (>1%), Paresthesia (>1%), Purpura (>1%), Vertigo (>1%)|
|Frequency Not Defined||Lightheadedness, Dizziness, Renal tubular necrosis, Euphoria, Dysphoria, Constipation, Pruritus, Skin and urticarial eruptions, Fatal hepatic necrosis, Drowsiness or sedation, Nausea and vomiting,|
|Postmarketing reports||Fever, Hyponatremia, Angioedema, Breast enlargement, Erythema multiforme, Blood glucose fluctuation, Elevated liver function tests, Jaundice, Stevens-Johnson syndrome, Changes in libido, Anorgasmia|
Special precautions and warnings during Gabapentin and Percocet administration:
- Patients should tell their doctor and pharmacist if they are allergic to Gabapentin or Percocet or any other medicines, or any of the inactive ingredients in Gabapentin or Percocrt products.
- Patients should also tell their doctor and pharmacist what prescription and nonprescription medicines, nutritional supplements, herbal products or vitamins, they are taking or plan to take. Patients using Gabapentin should mention if they are using some of the following drugs: hydrocodone, medicines that can cause dizziness or drowsiness, morphine and naproxen. Patients on Percocet therapy should mention if they are already using following drugs: diuretics, antidepressants; antihistamines, buprenorphine butorphanol; medications for glaucoma, ipratropium, nalbuphine; naloxone and pentazocine. Doctor may need to change the doses of medicines or monitor carefully for side effects.
- Patients who are using Gabapentin and antacids such as Mylanta or Maalox should take antacids at least 2 hours before they take gabapentin.
- Patients should tell their doctor if they have or have ever had kidney disease.
- Patients should avoid alcohol while using these medications. Drinking alcohol can increase certain side effects of these medications.
- Patients should tell their doctor if they are pregnant or plan to become pregnant, or are breast-feeding. Gabapentin should not be used during pregnancy and breastfeeding.
- Gabapentin and Oxycodone can make patients drowsy and dizzy, may slow their thinking and cause loss of coordination. They shouldn’t drive a car or operate machinery while using these drugs.
- If Gabapentin is given to a child, child’s mental abilities and behavior may change while taking gabapentin. These changes can be sudden changes in mood, hyperactivity, difficulties with concentration and attention, clumsiness and drowsiness.
- Patient should know that their mental health can change in unexpected ways and they may become suicidal while they are using gabapentin for the treatment of epilepsy, mental illness or other conditions. So, there is a risk that patients may experience changes in their mental health, but there may also be a risk that they will experience changes in their mental health if their helath condition is not treated. Decision should be made whether the risks of taking an anticonvulsant are greater than the risks of not taking it.
- Patients using Percocet should tell their doctor if they are having paralytic ileus. Doctor may tell them not to use this drug.
- Patients on Percocet therapy should also tell their doctor or pharmacist if they have or have ever had a blockage in their intestine or stomach; urethral stricture, enlarged prostate or heart, low blood pressure; seizures; Addison’s disease, thyroid, kidney, liver, pancreas, or gall bladder disease.
- Patients should also know that oxycodone may cause lightheadedness, dizziness, and fainting if they get up too quickly from a lying position. They should always get out of bed slowly, and rest their feet for a few minutes before standing up.
- Oxycodone may cause constipation. Patients should talk with their doctor about changing their diet or to use other medicines to prevent or treat constipation while they are on oxycodone treatment.
- Acetaminophen overdose can lead to acute liver failure. Acetaminophen administration shouldn’t exceed the doses of 4g per day.