Can you take gabapentin with tramadol?

Photo of author
Written By Dr. Marcus Yu Bin Pai

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Gabapentin and tramadol are medications that can be prescribed together for certain conditions, such as chronic pain. However, combining these medications can increase the risk of side effects, such as drowsiness, dizziness, and difficulty concentrating.

Some people may also experience impairment in thinking and judgment.

Indications for use of Gabapentin and Tramadol

Gabapentin and tramadol are both medications used to manage different types of pain, but they also have other uses.


Gabapentin is an anticonvulsant and nerve pain medication. It is licensed for use in the USA for the treatment of focal seizures and post-herpetic neuralgia, and in the UK for focal seizures and peripheral neuropathic pain.

It is also commonly prescribed off-label for a variety of conditions, including alcohol dependence and withdrawal, brachioradial pruritus, chronic refractory cough, diabetic neuropathy, fibromyalgia, hiccups, hot flashes, insomnia, restless legs syndrome (RLS), anxiety disorders, and uremic pruritus.

Gabapentin has also been used in the management of moderate to severe alcohol withdrawal syndrome.


Tramadol is an opioid analgesic used to treat moderate to severe pain, for postoperative pain, chronic pain, and cancer pain. Tramadol has also been used in research for the management of pain after impacted mandibular third molar extractions, and in the treatment of pain in companion animal.

It has been studied for its potential antitumor effects on endometrial cancer cells. Additionally, tramadol has been used in the prevention of intraoperative shivering in patients undergoing surgery under subarachnoid blockade.

Clinical Research indications of their associated use

The combination of gabapentin and tramadol is primarily utilized in the management of various types of pain, with its most significant applications being neuropathic pain, inflammatory pain, and postoperative pain management. These drugs, when used together, offer a synergistic effect, enhancing pain relief more effectively than when either is used alone.

In the context of neuropathic pain, such as that caused by diabetic neuropathy or peripheral neuropathy induced by chemotherapy agents like paclitaxel, the gabapentin-tramadol combination has shown remarkable efficacy. Studies, including those by Miranda et al. (2016) and Miranda et al. (2018), highlight this synergistic effect, particularly in reversing neuropathic pain and reducing associated inflammatory markers like IL-1α. This combination is beneficial in both human and animal models, offering a broader range of therapeutic applications for neuropathic pain, a condition often difficult to manage with traditional analgesics.

Another significant application of this drug duo is in postoperative pain management. For instance, the study by Sen et al. (2009) demonstrated the effectiveness of preoperative gabapentin in reducing postoperative pain intensity and tramadol consumption after surgeries like inguinal herniorrhaphy. This approach has been beneficial in reducing the reliance on opioids post-surgery, thereby mitigating the risks associated with opioid use.

Additionally, in veterinary medicine, as seen in the study by Rabbani et al. (2021), the combination has proven effective in managing postoperative pain in cats undergoing ovariohysterectomy, underscoring its utility across species. These instances reveal the versatility and efficacy of the gabapentin-tramadol combination in managing pain in various clinical scenarios.

  1. Inflammatory Pain Management (Granados-Soto & Argüelles, 2005):
    • Study Context: This study explored the interaction between tramadol and gabapentin in reversing formalin-induced nociception.
    • Findings: It was found that low doses of these drugs can interact synergistically for this purpose, suggesting a therapeutic advantage for clinical treatment of inflammatory pain.
  2. Diabetic Neuropathy (Miranda et al., 2018):
    • Research Aim: The study focused on treating pain induced by diabetic neuropathy.
    • Conclusion: The combination of gabapentin and tramadol was identified as a useful strategy for managing this type of pain.
  3. Acute Pain in Veterinary Medicine (Ruel & Steagall, 2019):
    • Study Area: This research was conducted in the context of small animal practice.
    • Application: Gabapentin and tramadol are used as adjuvant analgesics for treating acute pain in animals, especially when opioids are ineffective or contraindicated.
  4. Neuropathic Pain Treatment (Dworkin et al., 2003):
    • Objective: The study reviewed evidence-based approaches to neuropathic pain.
    • Recommendation: Gabapentin and tramadol are recommended based on the outcomes of randomized controlled clinical trials for neuropathic pain.
  5. Postoperative Pain in Cats (Rabbani et al., 2021):
    • Research Focus: The study examined the effects of these drugs in cats undergoing ovariohysterectomy.
    • Result: The addition of gabapentin to tramadol significantly improved analgesia, indicating effective pain management in this surgical context.
  6. Peripheral Neuropathy Induced by Paclitaxel (Zbârcea et al., 2017):
    • Study Goal: The research aimed at assessing pain management in peripheral neuropathy caused by paclitaxel.
    • Findings: The combination of gabapentin and tramadol showed maximum analgesic effect in this model, suggesting its potential use in similar human conditions.
  7. Postoperative Pain After Inguinal Herniorrhaphy (Sen et al., 2009):
    • Study Design: This study examined the effect of preoperative gabapentin on postoperative pain.
    • Outcome: It was found that a single preoperative dose of gabapentin reduced postoperative pain intensity, tramadol consumption, and long-term pain after inguinal herniorrhaphy.
  8. Experimental Mononeuropathic Pain (Miranda et al., 2016):
    • Research Aim: The focus was on assessing the interaction of tramadol and gabapentin in experimental neuropathic pain.
    • Conclusion: The combination was more effective in reversing neuropathic pain than either drug alone.
  9. Diabetic Neuropathic Mice Model (Miranda et al., 2018):
    • Objective: The study investigated the effect of the drug combination on interleukin-1α concentration in diabetic neuropathic mice.
    • Result: The combination reversed the increased concentration of IL-1α, indicating a potential therapeutic effect in diabetic neuropathy.
  10. Painful Idiopathic Small Fiber Neuropathy (Ho et al., 2009):
    • Study Context: The research focused on the treatment of painful idiopathic small fiber neuropathy.
    • Findings: Both gabapentin and tramadol were shown to be effective in treating this condition.

What does Clinical Research says?

Taking gabapentin with tramadol can have varying effects based on the context and dosage.

Parkinsonism and Movement Disorders Risk (Kairi Ri et al., 2023): This study, published in “Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy,” detected a safety signal for parkinsonism and related movement disorders associated with gabapentinoids or tramadol. The research suggests a potential risk when using these medications, indicating the need for cautious prescription and monitoring for movement-related side effects.

Rescue Medication Use (D. Simić & I. Milojević, 2008): In this study, gabapentin was used alongside tramadol as a rescue medication for treating sciatic nerve injury pain. Published in “Pediatric Anesthesia,” the study found no side effects in this particular usage, suggesting a safe application in the context of nerve injury pain management.

Synergistic Effect on Nociception (V. Granados-Soto & C. Argüelles, 2005): The study, appearing in the journal “Pharmacology,” explored the interaction of tramadol and gabapentin in reversing formalin-induced nociception. Researchers found that low doses of these drugs interact synergistically for this purpose, indicating a therapeutic advantage for clinical treatment of inflammatory pain.

Combination in Reversing Neuropathic Pain (H. Miranda et al., 2016): Published in “Basic & Clinical Pharmacology & Toxicology,” this study highlighted the synergistic effect of gabapentin and tramadol in reversing neuropathic pain. Both drugs’ effects were found to be dose-dependent and synergistic, suggesting an enhanced therapeutic potential when used in combination for neuropathic pain.

Preoperative Gabapentin Use (Harshel G. Parikh et al., 2010): In the “Saudi Journal of Anaesthesia,” this study reported that oral gabapentin given pre-operatively enhanced the analgesic effect of tramadol. This combination also reduced the requirement for rescue analgesia with Diclofenac, suggesting an effective strategy for managing post-operative pain.

Postoperative Pain Reduction (H. Sen et al., 2009; U. Srivastava et al., 2010): These studies, from the “European Journal of Anaesthesiology,” found that preoperative gabapentin decreased the intensity of acute postoperative pain and reduced tramadol consumption in procedures like inguinal herniorrhaphy and cholecystectomy.

Effectiveness in Treating Neuropathy (T. Ho et al., 2009): This research, published in “PAIN®,” demonstrated the effectiveness of gabapentin and tramadol in treating painful small fiber neuropathy. It indicates that both medications can be beneficial for this specific type of neuropathic pain.

Risk of Tramadol Overdose (C. Daubin et al., 2007): Published in “Clinical Toxicology,” this study warns of the severe side effects like refractory shock and asystole associated with tramadol overdose, especially when combined with CNS depressants. This finding underscores the importance of careful dosing and monitoring, particularly in combination therapy.


It is important to follow a healthcare provider’s instructions closely when taking these medications together. They will consider the patient’s specific circumstances and may adjust dosages accordingly to minimize the risk of adverse effects. Always consult with a healthcare professional before starting, stopping, or combining medications.


  1. Kairi Ri, Toshiki Fukasawa, Satomi Yoshida, Masato Takeuchi, K. Kawakami. “Risk of parkinsonism and related movement disorders with gabapentinoids or tramadol: A case‐crossover study.” Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2023.
  2. D. Simić, I. Milojević. “Acute myocarditis during anesthesia after rubella infection.” Pediatric Anesthesia, 2008.
  3. V. Granados-Soto, C. Argüelles. “Synergic Antinociceptive Interaction between Tramadol and Gabapentin after Local, Spinal and Systemic Administration.” Pharmacology, 2005.
  4. H. Miranda, V. Noriega, J. Prieto, Pilar Zanetta, R. Castillo, N. Aranda, F. Sierralta. “Antinociceptive Interaction of Tramadol with Gabapentin in Experimental Mononeuropathic Pain.” Basic & Clinical Pharmacology & Toxicology, 2016.
  5. Harshel G. Parikh, S. Dash, C. Upasani. “Study of the effect of oral gabapentin used as preemptive analgesia to attenuate post-operative pain in patients undergoing abdominal surgery under general anesthesia.” Saudi Journal of Anaesthesia, 2010.
  6. H. Sen, A. Sızlan, Ömer Yanarateş, M. Senol, G. İnangil, I. Sücüllü, S. Özkan, G. Dagli. “The effects of gabapentin on acute and chronic pain after inguinal herniorrhaphy.” European Journal of Anaesthesiology, 2009.
  7. U. Srivastava, Aditya Kumar, S. Saxena, A. Mishra, N. Saraswat, Sukhdev Mishra. “Effect of preoperative gabapentin on postoperative pain and tramadol consumption after minilap open cholecystectomy: a randomized double-blind, placebo-controlled trial.” European Journal of Anaesthesiology, 2010.
  8. T. Ho, M. Backonja, J. Ma, H. Leibensperger, S. Froman, M. Polydefkis. “Efficient assessment of neuropathic pain drugs in patients with small fiber sensory neuropathies.” PAIN®, 2009.
  9. C. Daubin, C. Quentin, J. Goullé, Damien Guillotin, P. Lehoux, O. Lepage, P. Charbonneau. “Refractory shock and asystole related to tramadol overdose.” Clinical Toxicology, 2007.
Website | + posts

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Leave a Comment