Reglan prescribed with Buprenorphine

Question
Dear Dr. Krempels, I have a Dwarf Hotot, which I brought to the vet because she was not eating or producing droppings. After treating with sub Q fluids to hydrate, the vet gave us meds to administer - Reglan along with Buprenorphine for pain. Later I read that Reglan should not be administered with narcotic painkillers. Could this combination hurt our rabbit?
Thank you.

Answer
Dear Victor,

The two drugs can sometimes act synergistically, each one increasing the effect of the other.  With opiates, this can depress respiratory and nervous system function and potentially cause other problems.  From www.healthcare.com:

"MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities."

Your bunny isn't likely to be driving heavy equipment, so motor coordination isn't a major thing.  But do watch for signs of excessive lethargy, slow respiration, etc.

Most of our vets would not be prescribing opiates to a bunny with GI tract slowdown, but your vet may have a particular reason for doing so.  If you are concerned, ask the vet to be sure what to look for.

Hope this helps!

Dana