Gabapentin and Dihydrocodeine

[HelenJS]

Hello, does anyone have experience in taking Gabapentin with Dihydrocodeine? I was on 5 x Gabapentin 300mg per day (1 in the morning and 4 at night). Gabapentin had worked well for me, but then I was waking with an attack of RLS at around 4am every morning. It usually took about an hour at least to get back to sleep. So I started taking 5 at night, which didn’t actually stop the 4am attack but I did get back to sleep faster. I’m going on my honeymoon in September and I really don’t want to be struggling with an early morning attack especially in a hotel room or somewhere where I can’t even get up out of bed and walk around much, so I asked my doctor (not my usual doctor) what can I supplement the Gabapentin with which would eliminate this attack. He gave me Dihydrocodeine 30mg tablets and told me to take 1 at night with the Gabapentin. But he emphasised that they are addictive (which I kind of knew anyway) but what really scares me is that he said they can cause respiratory failure when combined with Gabapentin, so I must be careful and also cut down my Gabapentin too, down to 3 x 300mg at night. I’m reluctant to cut the Gabapentin down this much, as it generally works well, and after reading advice on this forum I’m going to reduce my Gabapentin back to 4 x 300mg at night and split them into two tablets at tea time and then the other two two hours before bed, for better absorption. I’m thinking I am too worried now to take the Dihydrocodeine now, but at the same time I’m also worried that reducing the Gabapentin back down to 4 tablets at night might not be enough again, even though I’m splitting that dose. Can anyone reassure me that taking Gabapentin and Dihydrocodeine isn’t a death sentence? In addition, when I mentioned RLS to this doctor he said “What’s that?” And then when I mentioned augmentation which I had suffered from many years ago, he again said “What’s that?” He also said that the maximum dose for Gabapentin is usually 900mg per day. I came away from my appointment feeling that I shouldn’t have bothered going. Thanks in advance and I hope this all makes sense.

[SueJohnson]

Dihydrocodeine needs to be taken every 4 to 6 hours or you will have mini withdrawals. I wouldn't worry about it being addictive unless you have an addictive personality - eg to alcohol as an example. Yes opioids can cause respiratory failure when combined with gabapentin but many people on this forum use both together and unless you have respiratory problems it is unlikely it will be a problem but discuss this with your doctor.

You might want to try taking 600 mg 2 hours before bed, 600 mg 2 hours before that and then 600 mg 2 hours before that and see how that works. Or you could set an alarm for 3 am and take 600 mg then although that would be no fun for your bride on your honeymoon unless she is also able to quickly get back to sleep. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin daily."

[HelenJS in reply to SueJohnson]

Thanks for the advice, I tried staggering my doses last night and even though I woke during the night, it wasn’t with an RLS attack. Got up went to the loo and back to bed (I usually have a walk round the house half asleep trying to walk the attack off) and back to sleep. I didn’t take the Dihydrocodeine, so I think I might just keep on with the staggered Gabapentin and see how it goes. I would never have known about Gabapentin not being well absorbed over 600mg, thanks for that.

[SueJohnson in reply to HelenJS]

That's great. Hope it continues.😀

[sharon6748 in reply to SueJohnson]

Sue, you always give the best advice. I've always wondered about that (codeine and gabapentin and respiratory failure in some people) Also, about codeine being addictive if you have an addictive personality. Thanks Sue

[ELLSBELLS]

I have been taking Dihydrocodeine for many years and am not addicted, I had to try all other RLS medications with awful outcomes, so for me Dihydrocodeine has been a life saver. If opioids are the only treatment to give relief from RLS and a good quality of life we should not be afraid to take them

[HelenJS in reply to ELLSBELLS]

Thanks, that has reassured me, what dosage are you on? I’ve been prescribed one at night, so I’m a bit confused about possible withdrawals in between tablets.

[ELLSBELLS in reply to HelenJS]

I only used to take 1x 60mg at night because I only suffered night time RLS and had no withdrawal symptoms during the day. After augmenting on dopamine agonists I have RLS 24/7 and so needed another another 60mg during the day.. I have had to increase the dose ( after many years ) to 90mg am and pm. I do not think this is due to tolerance but more likely because I have developed chronic kidney disease and hypothyroidism plus I am 71 so a lot older. If your Dihydrocodeine is increased to 60mg get Dihydrocodeine Continus as it lasts a full 12 hours for me . Recently pharmacy could not obtain 90 mg so had to get prescription changed to 60 mg + 30 mg and this did not give 12 hours respite as 30 mg is not long acting.. Best of luck and hope this combination works for you.