Major
Gabapentin × Morphine
Gabapentinoids (antiepileptics)×Natural opium alkaloids
Mechanism
Gabapentin reduces morphine clearance and potentiates CNS depression. FDA issued a 2019 warning about increased respiratory depression risk with the combination.
Symptoms
Drowsiness, slowed breathing (rate below 12/min), cyanosis of lips. Severe cases include respiratory arrest. Older patients: fall risk.
Management
The combination is possible in neuropathic or palliative pain. Keep doses minimal, start low. Provide naloxone to the patient and family. Monitor respiratory rate and saturation.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.