Can You Take Gabapentin with Codeine?
Last reviewed: · Source: US FDA drug label database
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Gabapentin combined with codeine or other opioids significantly increases the risk of respiratory depression and death — this pairing carries an official FDA warning.
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Is it safe to take Gabapentin with Codeine?
The FDA and UK regulators have issued specific warnings about combining gabapentinoids (gabapentin, pregabalin) with opioids like codeine. Both suppress the central nervous system, and together they can dangerously slow breathing, particularly during sleep. UK overdose deaths involving gabapentinoids almost always also involve opioids. If both drugs are genuinely needed, they must be prescribed together deliberately at the lowest effective doses — never self-combine prescription gabapentin with over-the-counter co-codamol.
How do Gabapentin and Codeine interact?
Opioids depress brainstem respiratory drive via mu-receptor agonism. Gabapentin adds CNS depression and appears to blunt the hypercapnic ventilatory response, while opioids also increase gabapentin absorption. The combination produces synergistic — not merely additive — respiratory depression.
Data sourced from the US Food and Drug Administration (FDA) drug label database: FDA Drug Safety Communication 2019 — serious breathing problems with gabapentinoids and opioids.
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Everyone, but especially people with sleep apnoea, COPD or other lung disease, the elderly, those with kidney impairment (gabapentin accumulates), and anyone also drinking alcohol or taking benzodiazepines.
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What if I've already taken Gabapentin and Codeine?
If both were prescribed together deliberately, take exactly as directed and never increase doses yourself. If you've added OTC co-codamol to prescription gabapentin, stop the codeine and speak to a pharmacist. Emergency signs: extreme drowsiness, slow or shallow breathing, blue lips, unresponsiveness — call 999.
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Not sure if this combination is safe for your specific situation?
HealthLabs.com lets you check liver enzyme or kidney function levels before combining medications long-term — no GP referral needed.
Check your levels at HealthLabs →Always speak to your pharmacist or GP for personalised medical advice. Affiliate link — we may earn a commission.
Frequently Asked Questions
Can I take co-codamol with gabapentin?
Not without your prescriber's explicit approval. The codeine in co-codamol plus gabapentin can dangerously suppress breathing.
Why are gabapentin and opioids dangerous together?
Both depress the central nervous system and breathing. Together the effect is synergistic — much greater than either alone, especially during sleep.
What painkillers are safe with gabapentin?
Paracetamol and, for most people, NSAIDs like ibuprofen do not have this interaction. Check with your pharmacist for your situation.
What are the emergency warning signs?
Extreme sleepiness, confusion, very slow or shallow breathing, gurgling or snoring that's hard to rouse from, blue-tinged lips. Call 999 immediately.
Can I take co-codamol with gabapentin?
Not without your GP's explicit approval. Co-codamol contains codeine — and codeine combined with gabapentin can dangerously suppress breathing, particularly during sleep. The FDA issued a specific black box warning about this combination in 2019.
What painkillers are safe with gabapentin?
Paracetamol and NSAIDs (ibuprofen, naproxen) for most people — these don't have the respiratory interaction. Opioids including codeine, tramadol, and morphine must be avoided or used only at the absolute minimum dose under close medical supervision.
Why are gabapentin and opioids dangerous together?
Both depress the CNS and suppress respiratory drive through different but additive mechanisms. Gabapentin also appears to blunt the normal response to rising CO2 that prevents breathing from stopping — exactly the reflex that opioids also suppress. The combination is synergistically dangerous.
My GP prescribed both gabapentin and low-dose codeine — is that safe?
If deliberately co-prescribed, your GP has assessed the individual risk-benefit. Never increase either dose without guidance, avoid alcohol, ensure someone knows to check on you, and watch for excessive sedation or slow breathing.