MajorNatural opium alkaloids×Gabapentinoids (antiepileptics)
Updated · Methodology
Mechanism
Pregabalin acts via the α2δ subunit of calcium channels and depresses the central nervous system. Morphine suppresses the respiratory centre via μ-opioid receptors. Effects are additive.
Symptoms
Drowsiness, slowed breathing (rate below 12/min), cyanosis of lips. Severe cases include respiratory arrest. Older patients: fall risk.
Management
The combination is possible in neuropathic pain or palliative cancer pain with careful titration. Keep doses minimal, provide naloxone to the patient and family, monitor respiratory rate and saturation.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- AEMPS: Ficha técnica de MST Continus 10 mg comprimidos de liberación prolongada (morfina) (2024)– AEMPS CIMA, nregistro 57898, secciones 4.4, 4.5
- EMA: Ficha técnica (SmPC EMA) de Lyrica 100 mg cápsulas duras (pregabalina) (2024)– EMA SmPC vía AEMPS CIMA, nregistro 104279015 (EU/1/04/279), secciones 4.4, 4.5
- FDA: MS Contin (morphine sulfate) extended-release tablets prescribing information (2026)– FDA label, DailyMed setid c354b3bf-86c0-4bb8-8b1f-be2164942698, Boxed Warning, sections 5.3, 7
- FDA: Lyrica (pregabalin) prescribing information (2025)– FDA label, DailyMed setid 60185c88-ecfd-46f9-adb9-b97c6b00a553, sections 5.4, 6.2
- FDA: FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR) (2019)– FDA Drug Safety Communication, posted 12/19/2019