Gabapentin and Lyrica synergistic effects?

[GottaHaveIt]

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What are your opinions on using gabapentin AND pregabalin at the same time in select patients? Apparently there may be some synergistic effects? Just saw a patient from a different provider on the combo and they say they have been on them both for years...

Never heard of it in my training and I was kinda shocked to see it.

 

[deleted131481]

I have seen this a few times. The ones I've seen they like to take one during the day and the other at night so I was ok with it. Never had them take both at the same time.

Never heard anything about gaba/lyrica being synergistic, probably just additive. Bioavailabilty of lyrica is much better along the dose curve so maybe they took it on top of gabapentin and like it better.

 

[Orin]

Generally I don't think of medications acting synergistically unless they work through different mechanisms of action. The classic figure I go back to is one in the anesthesia tomes that comes from (Is synergy the rule? A review of anesthetic interactions producing hypnosis and immobility - PubMed)

In this case, I tell patients it may be additive/better, but it is uncommon that patients need both and they will be exposed to the combined risks of both: Potential Adverse Consequences of Combination Therapy with Gabapentin and Pregabalin

with that said, there are some pre-clinical and case reports suggestive of a synergistic benefit

Is there a role for combined use of gabapentin and pregabalin in pain control? Too good to be true? - PubMed

Gabapentin (Neurontin ¹ ) and pregabalin (Lyrica ² ) are first- and second-generation α2δ ligands, respectively, and are both approved for use as adjunctive therapy in pain control. Although they do not bind to gamma-aminobutyric acid (GABA) receptors they have been...

pubmed.ncbi.nlm.nih.gov