Gabapentin and Tylenol: Drug Interactions and Risks

Gabapentin (Neurontin) is a prescription drug that’s used to treat seizure disorders and nerve pain. It’s commonly used in a treatment protocol with different medications, including Tylenol (acetaminophen).

While both medications alleviate pain, they treat different kinds of pain. Using them together can provide more effective pain relief. However, it’s important to understand how to use these medications safely.

What Is Gabapentin?

Gabapentin, which is available under the brand name Neurontin, has been prescribed for seizure disorders and nerve pain since the 1990s. It may be used off-label for general nerve pain. Horizant, an extended-release version, is prescribed for restless leg syndrome, while Gralise, another extended-release version, is used for postherpetic neuralgia.

Gabapentin is a gamma-aminobutyric acid (GABA) analog drug.[1] This class of drugs reduces the activity of the nerve cells in the brain, relieving the effects of nerve pain. Like other anticonvulsants, it can also reduce the intensity, duration, or frequency of certain types of seizures.

Like other drugs, gabapentin has many possible uses, but there are side effects, adverse reactions, and possible interactions to be aware of.

What Is Tylenol?

Tylenol is a well-known brand name for acetaminophen, an analgesic (pain-relieving) medication used for mild-to-moderate pain instead of chronic pain, such as menstrual cramps, headaches, or muscle pain.

One of the reasons Tylenol is so popular is because it relieves pain quickly. It’s relatively safe if you stay within the normal dose range. This medication affects the central nervous system and is thought to raise the pain threshold, changing how your body perceives pain.[2] It can also reduce fever by targeting the heat-regulating area of the brain to lower an elevated temperature.

Is It Safe to Combine Gabapentin and Acetaminophen?

Gabapentin and acetaminophen are two different classes of drugs that work to relieve different types of pain and have different mechanisms of action. There are no known interactions between gabapentin and acetaminophen, but that doesn’t mean none exists.[3]

Can You Take Gabapentin with Tylenol?

Gabapentin and Tylenol are two different classes of drugs that work differently to relieve pain. There are no confirmed interactions between gabapentin and Tylenol, but that doesn’t mean an interaction can’t occur.[3]

If you have more than one type of pain, combining gabapentin and Tylenol can provide better relief. There’s evidence that taking a combination of these drugs can minimize pain after an operation. In the study from Yale University, the participants who were given both drugs before chest surgery didn’t need as high doses of opioid painkillers after surgery as those who didn’t have either medication before surgery.[4]

How to Take Gabapentin and Tylenol Together

Gabapentin is typically dosed on a set schedule, whereas Tylenol is taken as needed. If you’re taking the drugs together, you don’t need to separate the doses if your gabapentin dose is scheduled for the same time as you need another dose of Tylenol.

Keep in mind that Tylenol has limits on how often you can take it or the maximum daily dosage. Follow the directions on the label or speak with your doctor or pharmacist.

What Drugs Interact with Gabapentin?

Gabapentin is safe to use with Tylenol as part of your treatment, but there are other possible drug interactions to be aware of with these two drugs:

Opioids

Opioids like morphine, hydrocodone, and oxycodone are prescribed for pain management, but they have a different mechanism of action from gabapentin or Tylenol. Opioids block signals to numb the body to pain, which is why they’re often used for severe, chronic pain. They also have a high potential for substance use disorder (addiction) and should be used with caution.

Both gabapentin and opioids have similar side effects. Mixing the two can be dangerous, as you may experience severe sedation, respiratory depression, and other symptoms like loss of consciousness or extreme dizziness.

Gabapentin can amplify the depressant effects of opioids, which increases the risk of dangerous side effects, including respiratory depression. Gabapentin isn’t often abused on its own, though combining it with opioids can encourage repeated use and dependence. Taking opioids, especially at high doses, increases the risk of opioid overdose and serious side effects.[5] The FDA warned the public in 2019 about the risks of combining gabapentin and opioids and opioid overdose.[6]

Antihistamines

Antihistamines like Benadryl are widely available over the counter as a treatment for allergies and itching. These drugs block histamine, a chemical that regulates the immune response. Benadryl is diphenhydramine, but some other antihistamines have dizziness and drowsiness as side effects. If you take gabapentin with sedative antihistamines, it can cause dangerous respiratory depression.[7]

Sedatives

Sedatives include a range of medications used to treat insomnia and anxiety, including Ambien, benzodiazepines, and barbiturates. Like antihistamines, mixing gabapentin and sedatives can lead to severe levels of sedation.[8] Both of these drugs cause increased sedation and respiratory depression as a side effect.

Alcohol

Alcohol is a central nervous system depressant that slows the brain’s activity and breathing. Alcohol has many potential interactions, including other medications that have a sedative effect, like gabapentin. Taking gabapentin with alcohol can slow your body’s activity to dangerously low levels, possibly causing death.

These are common interactions for gabapentin, but it’s not a complete list. Discuss the other medications you’re taking with your doctor or pharmacist.

What Drugs Interact with Tylenol?

Tylenol is widely available over the counter, in combination medications, and as a prescription, but it can have serious interactions:

Other Acetaminophen-Containing Drugs

Acetaminophen (paracetamol) is a common ingredient in many medications, including combination cold medications like NyQuil and some pain medications like Excedrin Migraine and Midol. Because it’s found in so many medications, it’s easy to overdose accidentally.

Taking large amounts of acetaminophen has an increased risk of liver damage or overdose.[9] Side effects of acetaminophen overdose may include vomiting, nausea, constipation, and possible organ damage or death.[10]

Alcohol

Drinking alcohol affects nearly every organ in your body, including the brain, heart, and kidneys. Excessive alcohol use can cause liver damage, as can too much acetaminophen. If you drink alcohol, it’s recommended to limit your alcoholic drinks to one per day for women and two per day for men.

If you are taking acetaminophen, combining safe doses of acetaminophen with safe amounts of alcohol may be okay on occasion.[11] However, talking to your doctor about what’s safe for you is best. With the interaction risk, staying well below the recommended amount may be best–or avoiding the combination altogether.

Warfarin

Warfarin is an oral anticoagulant, known as a blood thinner, used to prevent and treat blood clots. Acetaminophen may amplify the effects of warfarin, which can raise your risk of bleeding.[12] If you’re taking warfarin, discuss whether it’s safe for you to take acetaminophen for pain.

These are common interactions for acetaminophen, but it’s not a complete list. Discuss the other medications you’re taking with your doctor or pharmacist.

Be Careful with Drug Interactions

Gabapentin and acetaminophen have no known interactions. The combination of gabapentin and acetaminophen may be effective in addressing different types of pain. However, it’s important to exercise caution when mixing these medications and discuss all medications you’re taking with your doctor.

Frequently Asked Questions