Gabapentin And Tramadol Together, Update #34

[greyhead]

Spencer saw his internist today. His IBD is well-controlled at the moment, and we've pretty much discontinued the budesonide, giving only metronidazole at 250 to 500 mg. per day depending on how he's doing. But he has lumbosacral stenosis (well-controlled with acupuncture/chiropractic for three years) and now the addition of significant pain at that hinge point mid-spine. He even started barking at Shane the last couple weeks if Shane gets too close while Spencer's lying down, seemingly afraid of being stepped on. The internist said to give him gabapentin and tramadol both. Gave him his first gabapentin this afternoon, and he has been sleepy, spacey, and somewhat uncoordinated. We took him for a little walk in the evening, and he had trouble going down stairs. We had to guide him down a paw at a time. He was otherwise entirely enthusiastic for the walk, though!

 

Now I have to decide whether to go ahead and give him another before bed. The instructions are for every 8 to 12 hours.

And I have to decide when to add the tramadol. I'll be gone tomorrow morning and have to leave again in the afternoon. Skip will be home but working and, necessarily, not entirely attentive. I'm kind of inclined to wait until tomorrow afternoon when I get home before I add in the tramadol too.

 

What has been your experience of introducing both these meds to a greyhound? Do you ease them into it as I'm inclined to do or just do it all at once? Spencer's being a senior (11-1/2) with a complicated history is affecting my thinking/feelings about this, but maybe I don't need to worry this much? Thanks for anything you can share.

Edited June 27, 2012 by greyhead

[JJNg]

What dose of gabapentin is he on? And how much tramadol did the vet recommend? Some dogs are more sensitive to these meds than others. If treating chronic pain, it wouldn't hurt to ease into it to decrease the sedating side effects.

 

My only personal experience with this combo was treating severe, acute pain in one of my greys, and I went straight to a higher dose every 8 hours given the degree of pain she was in. She actually didn't have any noticeable side effects.

[greyhead]

What dose of gabapentin is he on? And how much tramadol did the vet recommend? Some dogs are more sensitive to these meds than others. If treating chronic pain, it wouldn't hurt to ease into it to decrease the sedating side effects.

 

My only personal experience with this combo was treating severe, acute pain in one of my greys, and I went straight to a higher dose every 8 hours given the degree of pain she was in. She actually didn't have any noticeable side effects.

Wow, how fortunate to hear from you at this hour! He's on 300 mg. gabapentin and 50 mg. tramadol. I'm also wondering: if the gabapentin has a good response, will he even need the tramadol on top of it.

 

The internist also mentioned using Adequan, but our other grey takes that already, and it would be truly $$$ to have two large dogs on it. I'm wondering if I can find a bigger bottle than 5 ml., like maybe for horses, so it might be cheaper in higher volume.

Edited March 27, 2012 by greyhead

[KF_in_Georgia]

Sam doesn't have any problem with this combo. He gets 200mg of gabapentin and 50mg of tramadol, three times a day. (And he gets 500mg of methocarbamol--a muscle relaxer--at the same times.) He gets his pills on top of a meal, never on an empty stomach.

 

If I remember correctly, gabapentin takes about 48 hours or so to get to full strength. Could Spencer just be having a reaction to the doctor visit today? If his spine was manipulated a lot, that could account for the lack of coordination, at any rate.

 

Around here, Sam sleeps--but not any more than the other greyhound, who's not doped up. As a precaution, I've blocked off the stairs so that he doesn't try going up or down them when I'm not home; I don't want the boy with the bad back doing those spiral stairs--doped up or not. The vet says we could double the amount of tramadol, but I'm reluctant to do that. Dogs often have problems with panting and apparent anxiety on larger doses of tramadol.

 

Is Spencer on any other meds? We tried Sam on valium with the gabapentin, and that was a disaster, even at a low dose.

 

Sam is nearly 12, and he's suffering from spinal arthritis, a mildly herniated disk, and lung cancer. With the pills, he feels well enough to do zoomies in the living room.

 

If you can block Spencer away from hazards like stairs, I think I'd continue the meds on schedule and see if Spencer adjusts to the dosage. Try the gabapentin just every 12 hours at first, then maybe add half the tramadol dose for a day or so, then add the second half if you think it's needed. (Around here, if Sam laid down and stared at me--instead of sleeping as usual--then I felt it was time to add the tramadol.) Then you can shift one or the other of the meds to three times a day when that seems necessary.

 

Also, Sam's gabapentin is in 100mg capsules. I started him with three capsules a day, then as his problems advanced, I upped the dosage to two capsules at a time at breakfast; a few days later, two at dinner; then finally two at bedtime.

[JJNg]

Wow, how fortunate to hear from you at this hour! He's on 300 mg. gabapentin and 50 mg. tramadol. I'm also wondering: if the gabapentin has a good response, will he even need the tramadol on top of it.

Those are the same doses I had my girl on, and she weighs about 55 lbs. Gabapentin has a wide dose range, and for chronic pain, I'll sometimes start with 100 mg and work up to 300 mg over a couple weeks. And yes, if you get a good response from gabapentin alone, there's not reason you'd have to give the tramadol.

 

The internist also mentioned using Adequan, but our other grey takes that already, and it would be truly $$$ to have to large dogs on it. I'm wondering if I can find a bigger bottle than 5 ml., like maybe for horses, so it might be cheaper in higher volume.

It does come in a larger bottle for horses, but I'm not sure it would be any cheaper.

[KF_in_Georgia]

You answered the dosage question while I was typing.

 

Try to get the gabapentin in a smaller dosage, if you can, so you can start him on a smaller dose. The impression I got from a pharmacist at Walgreen's is that the 100mg and 300mg formulas are powder in a capsule, so they're not something that can be split; the only version that is split-able is the 600mg pill, and who wants to split that? A prescription of 180 Gabapentin capsules (100mg size) costs me $10.99 at Walgreen's with the Walgreen's prescription savings card.

 

Current wisdom from OSU is that a smaller dosage of gabapentin, administered more frequently, is more effective than large dosages administered less often. See if that argument will encourage your vet to rewrite the prescription.

 

(Why are we all awake at this hour?)

Edited March 27, 2012 by KF_in_Georgia

[greyhead]

Thanks, Kathy and Jen! I'd have thought this was past the bedtimes of most Easterners!

 

Kathy, Sam sounds like Spencer, minus the cancer. (Wow, that sounds almost flip, which isn't how I meant it, but I apologize. I'm very sorry about what you and Sam are going through.) The internist x-rayed him 5 months ago and thought she saw that mid-spine disk slipping, but the radiologist didn't confirm it. His acupuncture vet keeps identifying pain and stiffness around that area, and his behavior shows he's having a lot of trouble getting up and down. Fortunately, he demonstrated that trouble in the vet office today in just trying to lie down!

 

Also in response to your question, Kathy, besides metronidazole, Spencer is on .25 mg Soloxine twice a day, SAM-e (200 mg. for liver and cognitive help), and we're restarting Pepcid twice a day. I read earlier tonight that acid reducers inhibit uptake of gabapentin, so that might be why the vet started Spencer on a kind of high dose instead of the smaller one. But we'll compare notes in a day or two, and I'll mention the suggestion about smaller doses more often because it sounds like a good one.

 

Thanks to both of you for the dosing suggestions. Do they tend to stay on the gabapentin for life when the spinal problem gets this severe?

 

Edited on account of fatigue-induced stupidity.

Edited March 27, 2012 by greyhead

[KF_in_Georgia]

Sam and Spencer really are alike: Sam's gets soloxine and pepcid, too. (And Sam was born in 2000 and is a red fawn. But I checked on the database, and they aren't related.)

 

Sam will be on the gabapentin the rest of his life--and he's doing better than we thought he would, so he may make it to his 12th birthday (in May).

 

You might want to talk to Spencer's vet about methocarbamol. It's a muscle relaxer (aka Robaxin). When Sam's arthritis is bad, he tenses his back muscles and starts having trouble getting up and lying down--to the point where he screams when he tries. The methocarbamol has been a godsend for him.

 

(I'm having an all-nighter cleaning house. AT&T is coming to install U-verse in about 6 hours. I'm cleaning and rearranging furniture in the living room so the TV will be in the new location I want when he does the installation. And my girl greyhound, Silver, was spayed today, so I'm keeping an eye on her and making sure she behaves and leaves her stitches alone. Fortunately, I don't have to go back to work until Thursday.)

[tbhounds]

Seems I missed the all nighter!!! I also agree with the previous posts-- 300mgs sounds like a heavy dose of gabapentin to start with. The usual starting dose that I'm familar with is 100mgs 2-3 days daily and then working the dosage and frequency up from there. This will allow the body to adjust to the medication slowly. Of course with Osteo pain you would want more immediate response.

No need for the tramadol if you see improvement with the gabapentin - you could always add the tramadol as needed n the future.

[PatricksMom]

Patrick just came home with the hospital with 600mg of Gabapentin per day (split into 2 doses) and his tramadol increased from 200 to 300mg/day (split into 3 doses).

 

If I remember right, it was a long time ago, he started at 50mg of tramadol and worked up to 150 when it started working. He went to 200 a couple years ago as his arthritis progressed.

 

I guess I'd be less concerned about spacing them out and more concerned with checking in with your vet about what you're seeing before making decisions about going forward.

[Trihounds]

We've had good success with Gaba as well, in combination with Tramadol, but the latter causes drowsiness in Bumper, whereas the Gaba had very little side effect. Dosages were similar to what you have received. Seems to me you are on the right track though for us, the first thing to cut back on was the Tramadol given the drowsiness feature

[Sambuca]

Just an aside, but the meds treat different types of pain. If one does the job, great, but if not it doesn't mean it's not working.

[greyhead]

Just an update. Decided to skip the gabapentin last night since he'd had one at 2 p.m. And I went ahead and gave him half a tramadol instead of a whole one, just because he's never had it before and I was afraid he'd feel weird and start whining. He seems okay this morning, though he's still lounging around. I'll give him another gaba when he has breakfast, which has been anywhere from 9:00 to 1:00 lately (his choice). Hopefully, we'll talk to the vet again today or tomorrow, though I suspect phone tag will be happening today.

 

Hugs of thanks to you all for steadying and educating me last night, and special virtual scritchies to Sam and Patrick, and Silver too. They have been and remain in my thoughts and prayers.

 

ETA: I think the tech was supposed to discuss the meds with me before I left, but somehow that didn't happen and I didn't press the issue. Won't be making that mistake again!

Edited March 27, 2012 by greyhead

[racindog]

I have no experience with gabapentin. I did read however that you have to be careful because they now put xylitol in the human version sometimes and if you get it at a human pharmacy just be sure it is not one of the ones that has it in there.

Used tramadol on several hounds-never a problem-great pain reliever.

Edited March 27, 2012 by racindog

[Guest snakes]

FedX gets both meds for his OS, lots of people have posted about their experiences with these meds in the osteo thread. The gabapentin, as someone said, does take 48 hours to get to full strength in the body. Quite a few dogs have uncoordination when they first start it, as hence if you are in the situation to do so, starting slowly and increasing the dose every 2 days can make it a bit easier. We find that smaller dose spread out over the day works a lot better to control pain.

Currently FedX is on 300mg morning, 300mg noon, and 200mg night. This was a recent increase for him, previously for a long time he was getting 200mg morning, 100mg noon, and none at night (most of his activity is in the AM).

Tramadol i try to reserve for an "as needed" basis as the gabapentin works wonders for him. At one point he was also on 50mg tramadol twice a day in addition to the gabapentin. I favor the gabapentin because it works better with him and has very little side effects and doesn't affect other organs like tramadol.

 

I get gabapentin at Walgreens as well which is about $15/300capsules with their prescription saver plan.

[NeylasMom]

300 mg/day or /dose? 300 mg in a single dose is a LOT to start out with. It doesn't mean that he ultimately can't be on that dose, but to avoid side effects I would start lower and gradually increase. I found Neyla could tolerate as much as 300 mg every 8 hrs, but above that she got dizzy and disoriented, which is never what you want with a dog who already has an injury that would be exacerbated by falling.

 

I'm assuming you have 100 mg capsules? If so, I would start with 1 of those every 8-12 hours and let him adjust to that. Then add a second capsule and let him adjust.

 

Tramadol you can go up to probably about 150 mg 3x/day but that's also a very high dose (Neyla's max gabapentin btw was technically 500mg 3x/day; she weighed about 60 lbs). I would start with 25 mg Tramadol per dose and go from there. Tramadol does occasionally cause restlessness/panting, that sort of thing. Most do fine, but some dogs just don't seem to tolerate it well.

 

Of course, I would only add one thing at a time. The Gabapentin treats neurological pain btw, Tramadol is an opiate like pain reliever. I'd probably be inclined to see what a low dose of Gabapentin does for him first and then go from there.

[greyhead]

Spencer's gabapentin capsules are 300 mg each, and he's supposed to take 2 to 3 a day (8 to 12 hours). After he got his second dose this morning, he was fine -- no evidence of yesterday's ataxia.

In fact, he was trotting around like a new dog! The half Tramadol last night didn't cause him any distress, and I just gave him another half at 3 p.m. today. We'll see how things progress. I'm still reluctant to give him another gabapentin dose before bed. Missed out on contacting the internist today but will tomorrow, and will ask about the 100 mg capsules. They'll probably have his blood work back by then too; we did a pre-op panel, mainly to check his liver values, with a free-T4 add-on since we recently cut his Soloxine dose in half. But for now, going slow and easy, everything's fine. Thanks so much for everyone's input!

[PatricksMom]

So glad to hear he's doing well.

[NeylasMom]

Glad to hear things went better today. I wouldn't be too worried about giving the bedtime dose as the morning dose should have been processed by then.

[JJNg]

I have no experience with gabapentin. I did read however that you have to be careful because they now put xylitol in the human version sometimes and if you get it at a human pharmacy just be sure it is not one of the ones that has it in there.

The xylitol is only in the liquid formula, not the pills. The liquid would not be practical for a greyhound, but if you have a small dog or cat, this info about xylitol is important if your vet is prescribing gabapentin.

 

Glad to hear Spencer's doing well! Since it sounds like his spinal problem may be caused by a chronic disc compression, the chances are that he'll need to stay on the gabapentin for life. A slipped or bulging disc won't go away (without surgery), so the underlying condition causing the pain will always be present. However, just like in people, back pain can can wax and wane, so if he does really well for a while, you might be able to wean down on the dose, although you'd have to monitor closely for the need to go back up on the dose when he needs it again.

 

I also agree with Kathy's suggestion to ask your vet about methocarbamol. Back pain leads to secondary muscle spasms which make the pain worse. A muscle relaxer can be very helpful when used in conjunction with pain meds.

[GeorgeofNE]

George takes Gabapentin, but only 100 mg. There are no side effects other than an improvement in his night time grumpies! He takes the occasional Tramadol, but since LS is a NERVE problem, I'm never sure how much the Tramadol helps. I tend to only give it to him when he's done a mad zoomie session (on the leash) or gotten into and out of the car a few times. Or if he falls on the stairs.

 

I think the Tramadol has some side effects for him--one of them being INCREASED night time grumpies!

 

 

I gauge his comfort level in large part by his response to Da Ebil Won (my cat). When he's feeling fine, he's quite tolerant. When he gets snappy, I know he's uncomfortable (unless, see above, he's had his Tramadol).

 

He also takes 50 mg of Deramaxx daily. We tried reducing that to 35 mg., and his mysterious pee problem returned, so 50 mg it is. We have no idea what it is the Deramaxx is actually DOING, but when he takes it, he doesn't pee in the house. So we're monitoring his liver via blood work, and carrying on with our chemical cocktail.

Edited March 28, 2012 by GeorgeofNE

[NeylasMom]

George takes Gabapentin, but only 100 mg. There are no side effects other than an improvement in his night time grumpies! He takes the occasional Tramadol, but since LS is a NERVE problem, I'm never sure how much the Tramadol helps.

The LS puts a strain on their core muscles, so the Tramadol (or an NSAID or a muscle relaxant) may help with pain/soreness from increased use of those muscles, particularly the back muscles.

[racindog]

One comment from my experience with Cash. If you do the muscle relaxer it is best to start with the least dose possible. Cash initially improved after her sacral injury but was put on robaxin because of extreme muscle tightness etc. Then she suddenly went down again and got worse-erasing all the previous gains. The vet said that perhaps the robaxin dosage wa too high and it relaxed her so much the disc popper/slipped out again and so the dosage was halved but the damage was already done. So because of what I went through with Cash I would probably be a little scared about it.

[greyhead]

One comment from my experience with Cash. If you do the muscle relaxer it is best to start with the least dose possible. Cash initially improved after her sacral injury but was put on robaxin because of extreme muscle tightness etc. Then she suddenly went down again and got worse-erasing all the previous gains. The vet said that perhaps the robaxin dosage wa too high and it relaxed her so much the disc popper/slipped out again and so the dosage was halved but the damage was already done. So because of what I went through with Cash I would probably be a little scared about it.

This is a valid concern, I think. We keep it on hand for Shane when he needs it, which he seems to right now. (It never rains, it pours, right?) But I know Spencer relies on his musculature to keep his back end strong enough to weather the LSS, and I've seen him flex the muscles around the disk in question (thoraco-lumbar disk, I'm told, is that hinge disk between thoracic and lumbar vertebrae) to protect it when his regular vet was pushing on his hind quarters to see how his LSS was doing! Well, either he was flexing or spasming! But it's true, as jjng said, that he has muscle tremors that I've felt in his upper front legs; you can't see them happening, but you can feel them when you cup your hands around the muscles. So I think I'm going after any excess pain/tremors with tramadol as needed, and I'll give him whole tablets instead of halves.

 

Early this morning (6 a.m.) I heard Spencer issue a keep-away, warning bark at Shane. So I know he's not feeling entirely up to snuff, and it's still early in this treatment. I only gave him the gapapentin last night, not the tramadol. Now that I see he's handling both fine whenever he gets them, I'll go ahead and give both before bed. I hope there's no risk of respiratory depression by giving both simultaneously... The internist hasn't called yet, so I'll give them a shout this afternoon. But they're probably holding off until they get that free-T4 result back.

 

I imagine the size of the gabapentin dose was matched to his large size (77 lbs., 32 inches long and tall) and the degree of difficulty she could see him having just getting up and down, and also because it gives wiggle room for tappering down before discontinuing, if that were going to be possible. My feeling from everything I know of Spencer's condition and from what jjng and others have said is that he won't ever get off it. But maybe he'll be able to take a smaller dose after this more acute problem is soothed?

 

Thanks so much to all of you for helping me focus on the most important issues. The acupuncture/chiro treatments worked so well for such a long time, and the medicinal approach is completely new to me. Hugs to all your pooches too.

[NeylasMom]

You really don't need to be concerned about giving the 2 together, especially at the dosages you've mentioned. Both have pretty large safety ranges.