When two or more
medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a
Drug Interaction.
Tramadol interacts with CYP3A4 inducers such as
carbamazepine,
phenytoin, and
rifampin, which are used to treat
seizures and bacterial infections. The use of
Tramadol with CYP3A4 inducers may decrease the level of Tramadol in the blood which further results in reduced drug efficacy or withdrawal
syndrome in patients who have the physical dependence on Tramadol. In case of discontinuation of the combined use of CYP3A4 inducer with Tramadol, it may increase the level of Tramadol in the blood, which leads to increase the harmful effect of
opioid and may cause seizures, serotonin syndrome, and fatal slow or ineffective breathing. The patient taking
carbamazepine may decrease the pain-relieving (
analgesic) effect of Tramadol which leads to increase Tramadol metabolism and risk of seizure. If the use of Tramadol with the CYP3A4 inducer is necessary, the dose of Tramadol should be increased until the stable effects of the drug are achieved. Follow the patients for the signs of opioid withdrawal. If CYP3A4 inducer is discontinued, the dose of Tramadol should be reduced. Patients should be monitored for the signs of seizures, serotonin syndrome (serotonin-inducing symptoms), slow or ineffective breathing, and sedation. The use of carbamazepine with Tramadol should be avoided if the seizure occurs.
There may be an interaction of
Tramadol with CYP3A4 inhibitors such as macrolide
antibiotics (
erythromycin), azole-antifungal agents (
ketoconazole),
protease inhibitors (
ritonavir), which are used to treat bacterial, fungal and viral infections respectively. The use of
Tramadol with CYP3A4 inhibitors may increase the level of
Tramadol in the blood which results in increased metabolite levels. Patients should be monitored for serious harmful effects including
seizures, serotonin
syndrome (serotonin-inducing symptoms), and fatal slow or ineffective breathing, especially when the CYP3A4 inhibitors are added after a stable dose of Tramadol is achieved. In the case of discontinuation of the combined use of CYP3A4 inhibitors with Tramadol, it may decrease the level of Tramadol in the blood which further results in reduced drug efficacy or withdrawal syndrome in patients who have the physical dependence on Tramadol. If the use of Tramadol with the CYP3A4 inhibitors is necessary, the dose of Tramadol should be reduced until the stable effects of the drug are achieved. If CYP3A4 inhibitors are discontinued, the dose of Tramadol should be increased. Patients should be monitored for the signs of
opioid withdrawal syndrome.
Tramadol may interact with CYP2D6 inhibitors such as
quinidine,
fluoxetine,
paroxetine and
bupropion, which are used to treat heart disease and
depression. The use of
Tramadol with CYP2D6 inhibitors may result in an increased level of
Tramadol and decreased metabolite levels in the blood, especially when the CYP2D6 inhibitors are added after a stable dose of Tramadol is achieved. It results in decreased the effectiveness of Tramadol and may increase the risk of serious harmful effects such as
seizures, serotonin
syndrome, and withdrawal (after stopping or reducing intake of a drug) syndrome in patients who have the physical dependence on Tramadol. In the case of discontinuation of the combined use of CYP2D6 inhibitors with Tramadol, it may decrease the level of Tramadol and increased metabolite levels in the blood which may increase the harmful effect of
opioid and increase the risk of fatal slow and ineffective breathing. If the use of Tramadol with the CYP2D6 inhibitors is necessary, patients should be monitored for the signs of seizures, serotonin syndrome and opioid withdrawal. If CYP2D6 inhibitors are discontinued, the dose of Tramadol should be reduced until the stable effects of the drug are achieved, and such patients should be monitored for signs of slow or ineffective breathing and sedation.
Your doctor's guidelines may need to be followed while taking this medicine along with serotonergic drugs such as selective serotonin reuptake inhibitors (
SSRIs), tricyclic
antidepressants (TCAs), serotonin and
norepinephrine reuptake inhibitors (SNRIs),
5-HT3 receptor antagonists (
mirtazapine,
trazodone,
tramadol), triptans, which are used to treat
depression. The use of
Tramadol with serotonergic drugs may cause serotonin
syndrome (serotonin-inducing symptoms). If the use of Tramadol with serotonergic drugs is necessary, then the patient should be carefully observed while starting treatment and during dose adjustment. Treatment with Tramadol should be discontinued if serotonin syndrome occurs.
Special instructions need to be followed while taking this medicine along with central nervous system depressants such as benzodiazepines and other sedatives/hypnotics, antipsychotics, tranquilizers, anxiolytics, general anesthetics, muscle relaxants, other
opioids, which are used to treat
depression,
anxiety and muscle spasms. The use of
Tramadol with benzodiazepines or other CNS depressants may increase the risk of low blood pressure, slow or ineffective breathing, profound sedation,
coma, and possibly fatal. Patients should be monitored for the signs of slow or ineffective breathing or sedation. Limit the dosage or minimize the duration in such patients.
Your doctor's guidelines may need to be followed while taking this medicine along with
diuretics, which are used to treat blood pressure. The use of
opioids may reduce the effectiveness of
diuretics by releasing the antidiuretic
hormone. Patients should be monitored for the reduced diuresis (overproduction of urine) effects on blood pressure and the dose of diuretic should be increased as needed.
Special instructions need to be followed while taking this medicine along with muscle relaxants, which are used to treat muscle spasms.
Tramadol may increase the neuromuscular (muscle functioning) blocking effect of muscle relaxants and enhance the risk of slow or ineffective breathing. Patients should be monitored for the signs of slow and ineffective breathing and decrease the dose of
Tramadol or muscle relaxants as needed.
Tramadol interacts with mixed agonist/antagonist and partial agonist
opioid analgesics such as
butorphanol,
nalbuphine,
pentazocine,
buprenorphine, which are used to treat moderate to severe
pain. The use of
Tramadol with mixed agonist/antagonist and partial agonist opioid analgesics may reduce the pain-relieving (analgesic) effects of Tramadol and cause withdrawal symptoms. Patients should avoid the use of both medicines together.
There may be an interaction of
Tramadol with monoamine oxidase inhibitors (MAOIs) such as
phenelzine,
tranylcypromine,
linezolid, which are used to treat
depression. The use of
Tramadol with monoamine oxidase inhibitors may cause serotonin
syndrome (serotonin-inducing symptoms) and increase the harmful effect of
opioid such as
coma and slow or ineffective breathing.
Tramadol should not be used in patients taking MAOIs and within 14 days of stopping the MAOI therapy.
Tramadol may interact with
warfarin, which is used to treat blood clots. The use of
Tramadol with warfarin may increase prothrombin time (blood clotting parameter) and
ecchymose (
bleeding beneath the skin). Patients should take necessary precaution while using
Tramadol with warfarin. Dosage adjustment of warfarin and
regular monitoring of the prothrombin time should be needed in such patients.
There may be an interaction of
Tramadol with
digoxin, which is used to treat heart conditions. The use of
Tramadol with
digoxin may increase the harmful effects of digoxin. Patients should be monitored for the signs of harmful effects of digoxin and adjust the dose of digoxin as required.
Tramadol may interact with anticholinergic drugs, which are used to treat
asthma, motion sickness, and
diarrhea. The use of
Tramadol with anticholinergic drugs may increase the risk of severe
constipation, and inability to empty the bladder, which may cause intestinal
paralysis (paralytic
ileus). Patients should be monitored for the signs of reduced stomach muscle contractions (reduced gastric motility) and inability to empty the bladder when
Tramadol is used with anticholinergic drugs.
This page does not contain all the possible interactions of Tramadol. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any
medicines without the approval of your doctor.