Can you use amitriptyline and gabapentin together for fibromyalgia?

By OptimistMinds
Page last updated: 23/09/2022 | Next review date: 23/09/2024

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The Optimistminds editorial team is made up of psychologists, psychiatrists and mental health professionals. Each article is written by a team member with exposure to and experience in the subject matter.  The article then gets reviewed by a more senior editorial member. This is someone with extensive knowledge of the subject matter and highly cited published material.


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In this blog post, we are going to answer the question, “Can you use amitriptyline and gabapentin together for fibromyalgia?”. Both gabapentin and amitriptyline are approved to be used in the nerve-racking pain associated with fibromyalgia. 

This blog will cover the safety and efficacy of the concomitant use of amitriptyline and gabapentin. 

Can you use amitriptyline and gabapentin together for fibromyalgia? 

Yes, you can take amitriptyline and gabapentin together for fibromyalgia, but only if prescribed by your healthcare provider. Both amitriptyline and gabapentin help relieve the pain and can be a good combination, but at lower doses. 

Make sure you don’t take more than you’re supposed to. Higher doses will not provide better pain relief, instead they will start to make you feel even more sick. This is extremely important to monitor the kind of side effects the combination will give you. 

Both amitriptyline and gabapentin are considered troublesome meds. Amitriptyline has its fair share of side effects and the drug is not used as a first line of therapy, not even for depression and other mental illnesses. 

Gabapentin on the other hand, is considered one of the most dangerous drugs in the world and it does not work well for the majority of people. The combination of these two can cause some serious side effects and not everyone will be able to bear them. 

It is impossible to predict how your body will react once it is exposed to these medications. This is exactly why this treatment combination is not suitable for everyone and can be used only when the person can bear it. 

However, the treatment does hold clinical importance. One research survey revealed that the combination of amitriptyline, gabapentin and pregabalin are used at low doses for the management of fibromyalgia in India. 

The doses were carefully selected because all of these meds are capable of producing intolerable side effects. The doses were kept as low as possible, even after that some side effects are usually detected. 

What is the difference between amitriptyline and gabapentin? 

Amitriptyline is a tricyclic antidepressant (TCA). It works by inhibiting serotonin and norepinephrine transports, SERT and NET respectively. 

This way they can help increase the amounts of excitatory neurotransmitters in your system and cure your depression. TCAs are capable of binding to several other receptors in our body which leads to the effectiveness of this antidepressant for the management of fibromyalgia. 

Gabapentin, on the other hand, is a gamma aminobutyric acid (GABA) analog. Gabapentin mimics the actions of GABA, which is an inhibitory neurotransmitter. GABA works by inhibiting the excessive neuronal firing in the brain which reduces the frequency of epileptic seizures. 

Gabapentin is also used to reduce the intensity of neuropathic pain by inhibiting nociceptors (pain receptors). This medication is a prescription medication and should be taken only at doses determined by your healthcare professional. 

It is not recommended to start or stop using any medication, especially while you’re being on any medication that can affect your brain, with your doctor’s approval.

Make sure you use these two meds only when the combination treatment is preferred by your mental healthcare professional. Do not start any other medication along with your prescribed antidepressant. 

Self medication is one of the most common reasons for drug interactions and excessive side effects. It is also important to rule out any possible interaction between your prescription medications. 

What are the safety concerns with the concomitant use of amitriptyline and gabapentin for fibromyalgia? 

The concomitant use of amitriptyline and gabapentin may increase the risk of sedation, dizziness, fatigue, impaired senses and difficulty in concentrating. 

Elderly patients are more susceptible to these side effects and may suffer from additional effects like memory loss, impairment of motor coordination and troubled judgement. 

However, these two meds are still used together. The dose at which you take these two drugs can make a huge impact on your health. Higher doses can make you more susceptible to different kinds of side effects. 

Doctors usually adjust the doses when they prescribe more than one medication. Pre-existing health conditions are also considered before determining the appropriate dose.

One study suggests that amitriptyline has much more affinity for other receptors including cholinergic receptors. The more if binds to different kinds of active sites, the more side effects occur. 

Adverse effects of amitriptyline includes:

  • Painful urination 
  • Dry mouth or xerostomia
  • Gastrointestinal side effects, including nausea and vomiting 
  • Weight gain
  • Vertigo 
  • Drowsiness or extreme fatigue 
  • Constipation 
  • Abdominal pain
  • Enlarged breasts
  • Heartburn
  • Excessive sweating 

In severe conditions it can cause an allergic reaction, associated with painful rash, redness, pus filled blisters, itching, eczema, and burning sensation etc. It can also cause suicidal behavior in people older than 24 years of age. 

The effects of amitriptyline are unpredictable, because of its affinity to bind with multiple receptors. This is one of those drugs which are not that easily tolerated by a majority of the population. 

Amitriptyline can significantly cause QT elongation which can result in deadly arrhythmia. This class of antidepressants is well known for its cardiac toxicity. It can cause sudden cardiac arrest and death upon overdose. 

A 2004 study gathered all the data from different research studies and revealed 1000+ deaths caused by amitriptyline overdose. The study revealed that cardiac toxicity associated with amitriptyline is dose dependent. People at higher doses are also most likely to suffer from toxic effects. 

Gabapentin, on the other hand, is also associated with some serious side effects. These include:

  • Xerostomia or dry mouth 
  • Weight gain 
  • Dizziness 
  • Somnolence
  • Swollen hands and feet
  • Headache
  • Vision problems 
  • Cloudy mind
  • Fatigue
  • Tremors 
  • Confusion
  • Joint pain 
  • Difficulty in remembering things
  • Abdominal pain 
  • Unsteadiness
  • Muscle twitching 
  • Constipation 
  • Back pain
  • Increased appetite 
  • Fever

Gabapentin can cause some serious side effects. These include:

  • Suicidal behavior 
  • Impaired motor coordination 
  • Thrombocytopenia or decreased levels of platelets
  • Water retention
  • Rhabdomyolysis, a condition associated with abnormal breakdown of muscles
  • Convulsions 
  • Swelling or tenderness in different parts of the body.
  • Allergic reaction associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc.

Gabapentin is not an easy drug. Many researchers have observed dreadful effects of gabapentin and there are some people who have come forward to tell how they have lost their loved ones because of this medication. 

A 2019 forensic study that reviewed around 100+ cases revealed that gabapentin was responsible for death in all of those cases. The same study indicated that gabapentin is directly involved in the death of around 47% of the fatality cases. 

A pharmacist working in America called gabapentin ‘one of the most dangerous medications in America’. I’m sure he wasn’t just bluffing and gabapentin has somehow earned this title. 

At first it was believed that overdose of gabapentin is one of the major reasons of death caused by this medication and that it will not cause any such dreadful event when taken carefully and in doses determined by the healthcare provider. 

This indicates how much trouble the high doses will bring. Drug interactions should be an important consideration before taking two or more medicines together. Yes, drugs in combination are often used to achieve better therapeutic response but this is not the case with every interaction. 

Some drugs are highly incompatible with one another. They often cancel out each other’s effects or antagonise them. Some drugs are so incompatible that they end up changing the entire chemical composition of one another. 

Some interfere with metabolism or bioavailability (the rate and extent at which the active drug moiety enters systemic circulation/blood). This can lead to drug accumulation in different parts of the body. 

It is always advised to inform your healthcare provider of any medicine you take before getting a new prescription. Your doctor will make sure not to prescribe any such drug which might interfere with those you are already taking. 

Conclusion 

In this blog post, we have discussed the concomitant use of amitriptyline and gabapentin for fibromyalgia. The combination should only be used if prescribed by the healthcare provider. Both amitriptyline and gabapentin help relieve the pain and can be a good combination, but at lower doses. 

Make sure you don’t take more than you’re supposed to. Higher doses will not provide better pain relief, instead they will start to make you feel even more sick. 

The concomitant use of amitriptyline and gabapentin may increase the risk of sedation, dizziness, fatigue, impaired senses and difficulty in concentrating. Make sure you use this medication or any other medication only when your doctor has advised it. 

Using medications which can affect your brain is not something ideal and should not be encouraged unless it is absolutely necessary to do so. 

FAQs: amitriptyline and gabapentin together for fibromyalgia 

Can you take amitriptyline and gabapentin together?

Yes, you can take amitriptyline and gabapentin together for fibromyalgia, but only if prescribed by your healthcare provider. Both amitriptyline and gabapentin help relieve the pain and can be a good combination, but at lower doses. Make sure you don’t take more than you’re supposed to.

Which is better for fibromyalgia gabapentin or amitriptyline?

Both amitriptyline and gabapentin help relieve the pain and can be a good combination, but at lower doses. Amitriptyline is a tricyclic antidepressant (TCA). It has an affinity to bind to a number of receptors in the body and that is how it helps relieve the pain. 

Gabapentin, on the other hand, is a gamma aminobutyric acid (GABA) analog. Both can help relieve the pain to almost the same degree, but some people may be able to tolerate one of them better than the other. 

What is the drug of choice for fibromyalgia?

Gabapentin and pregabalin are usually the first choice of drugs for the treatment and management of fibromyalgia. Make sure you use this medication or any other medication only when your doctor has advised it. Using medications which can affect your brain is not something ideal and should not be encouraged unless it is absolutely necessary to do so. 

What drugs should not be taken with amitriptyline?

  • Monoaminoxidase inhibitors. The concomitant use increases the risk of serotonin syndrome.
  • Non-steroidal anti-inflammatory drugs (NSAIDS). The combination can increase the risk of bleeding 
  • Pimozide 
  • Alcohol 

Can you take gabapentin forever?

The duration of your treatment with gabapentin depends on the severity of your condition and how well you can tolerate this medication. Some people can not stand the long-term treatment because of the disturbing side effects, whereas others can function really well with this medication and they can use it for years. 

References 

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