Tramadol Drug Interactions

by on April 27, 2012

Tramadol is a prescription centrally-acting pain-killer. There is a number of medicines that can interact with Tramadol. Some of the combinations can lead to serious side effects, even coma and death. You should never take Tramadol if it has not been prescribed to you by a physician. Tell your doctor about any prescription drugs that you are taking as well as over-the-counter medicines, vitamins, herbal and other supplements.

Significant Tramadol drug interactions

  • Non-narcotic painkillers: The combination of Tramadol and common painkillers, such as Paracetamol or Aspirin, leads to stronger pain-alleviating effect. This is used in a number of combined drugs. However, do not take any other pain-killers along with Tramadol unless you have been advised so by your doctor.
  • MAO inhibitors: These are drugs used to treat depression.  As Tramadol induces serotonin release, it should never be used with MAO inhibitors, such as Moclobemide (Aurorix), Isocarboxazid (Marplan). Even Patients that have been on treatment with MAO inhibitors for the last 14 days should not be prescribed Tramadol. The combination can lead to agitation, delirium, increased body temperature, headache, low or high blood pressure, rigidity, convulsions and even coma and death.
  • Selective serotonin re-uptake inhibitors (antidepressants):  The avoidance of such combination is recommended as there is an increased risk of seizures or the development of serotonin syndrome. This group of drugs includes Escitalopram (Lexapro), Citalopram (Celexa), Paroxetin ( Seroxat), Fluoxetine (Prozac), Sertraline (Zoloft) etc.
  • Centrally acting medicines: Any centrally acting medicines, such as antidepressants, anaesthetics, anti-anxiety medications, St John’s wort, sleeping pills, Lithium, ADHD meds (Adderal, Concerta), medications used for treating any psychiatric disorders or alcohol can increase the side effects and especially the sedating effect of Tramadol. In some cases there is an increased risk of seizures or respiratory depression.
  • Carbamazepine: The concomitant use with Carbamazepine (Tegrtol) may lead to a weaker pain-alleviating effect of Tramadol since Carbamazepine increases the metabolism of Tramadol. Carbamazepine is a drug prescribed for treating epilepsy. The use of Tramadol by patients suffering from epilepsy is not encouraged as Tramadol decreases the seizure threshold.
  • Warfarin:  Patients taking Warfarin should be monitored very carefully as several cases of increased INR and spontaneous bleeding have been reported. Regular labs are recommended.

Drugs that inhibit the action of CYP3A4 - an enzyme that is mainly responsible for the metabolism of Tramadol in the liver- can interfere with the metabolism of Tramadol. Such patients should be given a very low dose of Tramadol. These include some antifungal medicines, such as ketokonazole (Nizoral), Fluconazole (Fungolon), Itraconazole (Orungal) and some antibiotics, such as erythromycin and Clarythromycin (Fromilid).

The combination with some other narcotic pain-killers, such as nalbuphine (Nubain), pentazocinhas to be avoided as it often results in a weaker pain-relieving effect.

Other drugs that may potentially interact with Tramadol:

  • Some heart-rhythm medications, such as Amiodarone (Cordarone), Propafenone (Rythmol)
  • Blood pressure medication such as Diltiazem( Tiazac), Verapamil (Isoptin)
  • Some HIV/AIDS drugs
  • Some cancer medications, such as Gleevec.

This list does not contain all the medications that can interact with Tramadol. Always inform your physician about any prescription or over-the-counter drugs, herbs or dietary supplements you are taking.