Lyrica and Opiods

I just read that taking Lyrica and opiods together is extremely dangerous. I don’t know if anyone has been prescribed this combination. I think I was prescribed both, but not together. I hope everyone is feeling well today.

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Actually it’s no more dangerous than taking 2 opioids together, or, any two meds in the same category or with the same possible side effect, really.

What you have to remember is that ALL drugs interact with each other and you MUST check side effects for all medications before taking them. WebMD has a great drug interaction tool you can use before taking anything (be it prescription or supplemental). Or, of course, speak to your pharm!

In terms of lyrica and narcotics specifically both these items impair judgement (ex: do not drive heavy machinery until you know how the medication affects you) and both depress breathing – indiv possibly suppressing breathing is not a big deal but when you start layering your meds the odds of suppression increases and becomes more dangerous (think of the actor Heath Ledger falling asleep for an afternoon nap with a terrible head cold and never waking up, the combination of prescription drugs and OTC cold meds he took suppressed his breathing to the point of killing him).

And because both can impair judgement you simply have to be aware of what you’re taking when as you start out/as you’re adjusting to the meds.

Actually I suggest keeping a log the first 2 or 3 weeks so you know exactly what you took when, especially if you also take as-needed pain meds.

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I have been given this combination by my Dr with the words that this combination works synergistically and so both meds can be taken at low doses, when taken together. That was the idea, at least. In my case it didn’t work and I stopped taking them.

Hi, I wrote that because I had just read this: I looked up pregabalin and it’s Lyrica

Greater Risk for Opioid-Related Death in Patients Coprescribed Pregabalin

Coprescription of pregabalin and opioids is associated with greater risk for dying than prescription of opioids alone, according to an Annals of Internal Medicine study.

Using Canadian prescription records, researchers matched 1400 patients who died from opioid-related causes to 5100 patients who were prescribed opioids but did not die. Being prescribed pregabalin in the prior 120 days was associated with increased mortality risk after adjusting for confounders (odds ratio, 1.68). Risk increased with higher pregabalin doses.

The researchers conclude:The importance of our finding warrants a revision of the pregabalin product monographs.

In an editorial, FDA officials say they are evaluating whether a label change is required. They write, “We need to keep in mind that both gabapentinoids and opioids have an appropriate role in pain management. As we work to better understand potential interactions, we also need to try to avoid inadvertently increasing prescription drug use or abuse through future regulatory actions”

As with any medications, you should check for any interactions. With that being said, pregablin and most prescription opioids are generally well tolerated. When starting out on any new medications or combination of medications, you should start out at the lowest dosages possible.
The results of the study that you have mentioned are questionable due to the fact that they used high dosage of pregablin and that the people had multiple comorbidities which almost always will result in a higher mortality rate.
Opioids and pregablin together are generally well tolerated under a doctor’s supervision. Of course, everyone is different and what works for one may not work for another. Pregablin all by itself does carry it’s own allergic reactions from minor to severe. You should try it first before adding any additional medications. The trial period should be at least one month. If you have no problems with it, then introduce opioids.

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Of course, always listen to your doctor.

I was on that combination for over 6 months… from memory Lyrica 75mg twice per day, roughly 50 mg oxycodone slow release, up to 10 mg oxycontin per day. I had zero problems. I could feel no benefit/advantage from the Lyrica. We scaled it down and out with no change or benefit. Opioids do help, providing a better quality of life on occasions, but you have to manage your usage. Tolerance will build quickly, and benefit disappear, if you do not regularly withdraw from them.

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Actually I’m going to disagree on the topic of tolerance. Most of the studies and information on tolerance have to do with how cocaine addicts and alcoholics need more to get the same high. Because cocaine is a cross drug to opioids the information is being applied to narcotic use. I don’t think it’s a good comparison.

Specifically it’s not a good comparison because it’s been proven in numerous studies that if you are treating true and real pain with a narcotic addiction is basically impossible – it falls somewhere below 2% overall when treating true physical pain. It seems to me that would negate any comparison to cocaine use, regardless of how similar the impact of cocaine and opioids are on the brain.

Here’s a summary of tolerance from one research study:

Although tolerance to most of the side effects of opioids (e.g., respiratory depression, sedation, nausea) does appear to occur routinely, there is less evidence for clinically significant tolerance to opioids– analgesic effects (Collett, 1998; Portenoy et al., 2004). For example, there are numerous studies that have demonstrated stable opioid dosing for the treatment of chronic pain (e.g., Breitbart, et al., 1998; Portenoy et al., 2007) and methadone maintenance for the treatment of opioid dependence (addiction) for extended periods (Strain and Stitzer, 2006). However, despite the observation that tolerance to the analgesic effects of opioid drugs may be an uncommon primary cause of declining analgesic effects in the clinical setting, there are reports (based on experimental studies) that some patients will experience worsening of their pain in the face of dose escalation (Ballantyne, 2006).

The entire study is here:

Keep in mind that you would never suggest an insulin-dependent diabetic regularly withdraw from insulin to keep the medication effective at the same level. The level of medication is adjusted, not the use. I personally believe that chronic pain should be managed the same way.

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