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Can Gabapentin Be Taken Along With Paroxetine, Primidone And Propranolol?
Question: I have been prescribed Gabapentin 100mg capsules to try and relieve the pain of sciatica (spelling?). I have tried Tylenol Extra Strength as well as Tramadol which was no better than Tylenol. I also have Essential Tremor and I noticed that Gabapentin is also used for that. I take Paroxetine, Primidone, and Propranolol for that Tremor condition. What is your opinion of these medications taken together. All have been prescribed by my Doctor.
Brief Answer:
There are some concerns
Detailed Answer:
Hello,
Although you may take all these drugs without any serious consequences, there are some concerns and certain patients may experience side effects.
Let me start from the most obvious one, central nervous system (CNS) depression which may occur with tramadol, gabapentin, primidone and paroxetine. When used in combination the risk for significant CNS depression is higher but cannot be predicted on an individual basis.
Regarding the beta-blocker: some drugs may potentiate its effects, others may do exactly the opposite. This is unpredictable on an individual basis as well. Paroxetine may potentiate the effects of propranolol. Primidone may reduce plasma levels of propranolol.
Liver injury from tylenol may occur more frequently when using it with primidone but it usually involves overdosage cases.
Finally, there are some infrequently occurring side effects like serotonin syndrome. This syndrome may occur more often with concomitant use of paroxetine and tramadol. This syndrome can be fatal but is - thankfully - rather uncommon and also can't be predicted on an individual basis as the rest of the side effects.
An alternative approach might have been to use low doses of more drug classes including the NSAIDs (like ibuprofen for example) unless there are other contraindications like peptic ulcer, chronic kidney disease, etc. Tylenol, NSAIDs and opioids act synergistically when used together, which means that pain relief is maximal when combining them.
I hope you find my comments helpful!
Regards,
Dr. Panagiotis Zografakis, Internal Medicine Specialist
There are some concerns
Detailed Answer:
Hello,
Although you may take all these drugs without any serious consequences, there are some concerns and certain patients may experience side effects.
Let me start from the most obvious one, central nervous system (CNS) depression which may occur with tramadol, gabapentin, primidone and paroxetine. When used in combination the risk for significant CNS depression is higher but cannot be predicted on an individual basis.
Regarding the beta-blocker: some drugs may potentiate its effects, others may do exactly the opposite. This is unpredictable on an individual basis as well. Paroxetine may potentiate the effects of propranolol. Primidone may reduce plasma levels of propranolol.
Liver injury from tylenol may occur more frequently when using it with primidone but it usually involves overdosage cases.
Finally, there are some infrequently occurring side effects like serotonin syndrome. This syndrome may occur more often with concomitant use of paroxetine and tramadol. This syndrome can be fatal but is - thankfully - rather uncommon and also can't be predicted on an individual basis as the rest of the side effects.
An alternative approach might have been to use low doses of more drug classes including the NSAIDs (like ibuprofen for example) unless there are other contraindications like peptic ulcer, chronic kidney disease, etc. Tylenol, NSAIDs and opioids act synergistically when used together, which means that pain relief is maximal when combining them.
I hope you find my comments helpful!
Regards,
Dr. Panagiotis Zografakis, Internal Medicine Specialist
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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