Gabapentinoids Any (preferably scientific) data about safe combination dose range of pregabalin with opioid analgesics?

[johngeologist]

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.

 

[negrogesic]

You will not find such data. These sorts of things are rarely studied in such an explicit fashion (ie, what dose of pregabalin is safe to combine with opioid x), unless said combination is particularly toxic, or the interaction has therapeutic implications (for instance combinations of antiviral medications). This is because, if there hasn't been an especially significant problem with the combination (or if there isn't a potential economic gain knowing the results), no one will fund the research.

Generally gabapentinoids increase the risks posed by opioids to a degree (though significantly less so than benzodiazepines). There is some research on this risk (they defined high dose pregabalin as above 300mg): https://www.acpjournals.org/doi/10.7326/M18-1136?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub 0pubmed

Essentially you have to evaluate your own risk factors (age, respiratory function, etc) and tolerance to both drugs to assess the risk. This is what also makes such research difficult and unattractive since it is almost impossible to conduct research and conclude, "a safe dose of codeine and pregabalin is X mg and Y mg" since risk factors vary widely, and ignores the phenomenon of tolerance.

 

[mdaniel80]

relevant though not peer-reviewed data:

Opioids - Phenibut and mu-agonist potentiation

I thought i should bring this up, as i don't seem to see it specifically addressed, and i feel like we should because someone could easily dose phenibut with heavy opiates and die. IME, phenibut potentiates kratom and regular mu receptor agonists by what feels(subjectively) to me like somewhere...

bluelight.org

Combining phenibut and opiates?

Does anyone have any experience combining phenibut with opiates, specifically heroin but any true opiate as opposed to kratom? And if so how where the effects? Did you find the respiratory depression to be greater or lesser than with benzodiazepines? I have combined it with kratom before and I...

bluelight.org

 

[TGuru]

Everyone is talking about 600mg treshlod 600mg because of seizures.

I’m on bupe 8mg daily and once a week I took 1g (1000mg) of it and the synergy is fucking great,
I have now WD’s from Lyrica howerer, I’m doing it for a couple of years.

600mg is prescribed.