What are the potential drug interactions with tramadol. How does tramadol interact with other medications and herbal supplements. What precautions should be taken when using tramadol in combination with other drugs. How can pet owners and healthcare providers minimize the risks associated with tramadol drug interactions.

Understanding Tramadol: A Synthetic Opioid for Pain Management

Tramadol is a synthetic opioid primarily used to treat pain in dogs, cats, and other small mammals. It’s important to note that its use in veterinary medicine is often considered ‘off label’ or ‘extra label’. This means that while the drug is approved for human use, it’s being prescribed for animals based on the veterinarian’s professional judgment.

Brand names for tramadol include Ultram®, ConZip®, Durela®, Ralivia®, Rybix®, Ryzolt®, Tridural®, and Zytram®. When prescribed for pets, it’s crucial to follow your veterinarian’s instructions carefully, as they may differ significantly from the label directions intended for human use.

How is Tramadol Administered to Pets?

Tramadol is typically given orally in the form of tablets, capsules, or a compounded liquid. It can be administered with or without food, but due to its bitter taste, giving it with food may be necessary. If your pet experiences vomiting when the medication is given on an empty stomach, try offering it with food or a treat in future doses.

For liquid forms of tramadol, accurate measurement is crucial. The medication usually takes effect within 1 to 2 hours, with clinical improvements following shortly after. However, in cases of chronic pain, it may take up to a few weeks before the full effects are observed.

Potential Side Effects and Risks of Tramadol in Pets

While tramadol can be an effective pain management tool, it’s important to be aware of potential side effects. These can vary between dogs and cats:

Side Effects in Dogs:

• Sedation
• Tremors
• Dizziness
• Anxiety
• Decreased appetite
• Vomiting
• Diarrhea
• Constipation

Side Effects in Cats:

• Vomiting
• Constipation
• Sedation
• Dilated pupils
• Uneasy feeling

In more severe cases, adverse effects may include seizures, incoordination, extreme sleepiness, agitation, or fast heartbeat. These symptoms could indicate an overdose, and veterinary attention should be sought immediately if observed.

Tramadol Drug Interactions: What Pet Owners Need to Know

When it comes to tramadol, understanding potential drug interactions is crucial for ensuring your pet’s safety and the medication’s effectiveness. Several medications and supplements can interact with tramadol, potentially altering its effects or causing adverse reactions.

Key Medications That May Interact with Tramadol:

• Antidepressants
• Azole antifungals
• Cimetidine
• Cyproheptadine
• Digoxin
• Ketamine
• MAO inhibitors
• Metoclopramide
• Ondansetron
• Other opioids
• Quinidine
• SAMe
• Sevoflurane
• SSRI and tricyclic antidepressants
• Warfarin
• Yohimbine

It’s essential to inform your veterinarian about any medications, vitamins, supplements, or herbal therapies your pet is taking. This information allows for a comprehensive assessment of potential interactions and helps ensure your pet’s safety.

Tramadol and Warfarin: A Potentially Dangerous Combination

One particularly noteworthy interaction involves tramadol and warfarin, an anticoagulant medication. Evidence from both local and international case reports suggests that this combination can lead to an elevated International Normalised Ratio (INR) in some individuals, potentially resulting in bruising or hemorrhage.

Key Points About the Tramadol-Warfarin Interaction:

1. The interaction typically occurs 3-4 days after tramadol is initiated in patients already stabilized on warfarin.
2. The exact mechanism of this interaction has not been fully determined.
3. Healthcare providers should be vigilant when prescribing tramadol to patients on warfarin therapy.
4. Close monitoring of INR levels may be necessary when these medications are used concurrently.

While this interaction is primarily observed in human patients, it underscores the importance of caution when combining tramadol with other medications, even in veterinary applications.

Precautions and Contraindications for Tramadol Use in Pets

To ensure the safe use of tramadol in pets, certain precautions and contraindications should be considered:

Tramadol Should Not Be Used In:

• Pets with hypersensitivity to opioids
• Cats in combination with acetaminophen (Ultracet®), as acetaminophen is extremely toxic to cats

Use Tramadol with Caution In:

• Patients with seizure disorders
• Pets with liver or kidney disease
• Geriatric or debilitated animals
• Pregnant or lactating pets

Additionally, tramadol should not be used in conjunction with medications that decrease brain or lung function. Always consult with your veterinarian about the appropriateness of tramadol for your pet’s specific health condition and medication regimen.

Proper Storage and Handling of Tramadol

Ensuring proper storage of tramadol is crucial for maintaining its effectiveness and safety. Here are the key guidelines for storing tramadol:

Storage Instructions for Tramadol Tablets and Capsules:

• Store at room temperature, around 25°C (77°F)
• Keep away from moisture and light
• Temperature excursions between 15°C to 30°C (59°F to 86°F) are permitted
• Avoid exposure to extreme heat or cold

Storage Instructions for Liquid Tramadol Preparations:

• Typically require refrigeration
• Always follow the specific storage recommendations on the product label

Proper storage helps maintain the medication’s potency and prevents degradation, ensuring that your pet receives the full benefit of the prescribed dose.

Monitoring and Managing Tramadol Use in Pets

While there’s no specific monitoring required for pets on tramadol, vigilance is key to ensuring its safe and effective use. Here are some important aspects to consider:

At-Home Monitoring:

• Observe your pet for any adverse effects
• Monitor for signs of pain relief and improved mobility
• Keep track of dosing schedule and any missed doses

Veterinary Follow-ups:

• Your veterinarian may schedule check-ups to assess the medication’s effectiveness
• Regular evaluations can help adjust dosage if needed
• Discuss any concerns or observed side effects with your vet

Remember, never adjust the dosage or discontinue tramadol without consulting your veterinarian first. Abrupt cessation can lead to withdrawal symptoms in pets who have been on the medication for an extended period.

Emergency Situations: When to Seek Immediate Veterinary Care

Recognizing signs of an adverse reaction or overdose is crucial for pet owners administering tramadol. If you observe any of the following symptoms, it’s important to seek immediate veterinary attention:

Signs of Potential Tramadol Overdose or Adverse Reaction:

• Seizures
• Incoordination
• Extreme sleepiness
• Agitation
• Rapid heartbeat

In case of an emergency:

1. Contact your veterinary office immediately
2. If your regular veterinarian is unavailable, follow their directions for contacting an emergency facility
3. Provide as much information as possible about your pet’s condition and the amount of tramadol administered

Quick action in these situations can be life-saving for your pet. Always keep your veterinarian’s emergency contact information readily available.

Maximizing the Benefits of Tramadol While Minimizing Risks

To ensure the best outcomes when using tramadol for your pet, consider the following strategies:

Best Practices for Tramadol Administration:

• Always follow your veterinarian’s dosing instructions precisely
• Use a pill organizer or set reminders to maintain a consistent dosing schedule
• Keep a log of doses given and any observed effects or side effects
• Store the medication securely, out of reach of children and other pets

Communication with Your Veterinarian:

• Provide a complete list of all medications and supplements your pet is taking
• Report any changes in your pet’s behavior or health status promptly
• Ask questions about potential drug interactions or side effects
• Discuss alternative pain management options if tramadol is not providing adequate relief

By maintaining open communication with your veterinarian and closely following their guidance, you can help ensure that tramadol provides effective pain relief for your pet while minimizing the risk of adverse effects or drug interactions.

The Future of Pain Management in Veterinary Medicine

As research in veterinary pharmacology continues to advance, new insights into pain management for pets are emerging. While tramadol remains a valuable tool in the veterinary arsenal, ongoing studies are exploring alternative treatments and refining our understanding of existing medications.

Emerging Trends in Veterinary Pain Management:

• Development of species-specific pain medications
• Integration of complementary therapies like acupuncture and physical therapy
• Advancements in long-acting pain relief formulations
• Increased focus on multimodal pain management approaches

As pet owners and veterinary professionals, staying informed about these developments can help ensure that our animal companions receive the most effective and safest pain management possible. Always consult with your veterinarian about the latest treatment options available for your pet’s specific needs.

Tramadol | VCA Animal Hospital

What is tramadol?

Tramadol (brand names: Ultram®, ConZip®, Durela®, Ralivia®, Rybix®, Ryzolt®, Tridural®, Zytram®) is a synthetic opioid used to treat pain in dogs, cats, and other small mammals.

Its use in small animals to treat pain is ‘off label’ or ‘extra label’. Many drugs are commonly prescribed for off label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully as their direction may be significantly different from those on the label.

How is tramadol given?

Tramadol is given by mouth in the form of a tablet, capsule, or a compounded liquid. It may be given with or without food, but due to its bitter taste, giving it with food may be required. If vomiting occurs when given on an empty stomach, give future doses with food or a treat. Liquid forms of this medication should be measured carefully.

Never give tramadol with acetaminophen (Ultracet®) to cats, as acetaminophen is extremely toxic to cats.

This medication will usually take effect quickly, in about 1 to 2 hours, and improvement in clinical signs should follow. However, in pets with chronic pain,  this medication can take up to a few weeks before full effects are noted.

What if I miss giving my pet the medication?

If you miss a dose, give it when you remember, but if it is close to the time for the next dose, skip the dose you missed and give it at the next scheduled time, and return to the regular dosing schedule. Never give your pet two doses at once or give extra doses.

Are there any potential side effects?

Side effects could include sedation, tremors, dizziness, anxiety, decreased appetite, vomiting, diarrhea, or constipation in dogs. In cats, possible side effects include vomiting, constipation, sedation, dilated pupils, or uneasy feeling.

Adverse effects may include seizures, incoordination, extreme sleepiness, agitation, or fast heartbeat, and these may be signs of an overdose. Contact your veterinarian if you note these signs.

This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

Tramadol should not be used it pets that are hypersensitive to opioids. It should be used with caution in patients with seizure disorders, liver or kidney disease, or in geriatric, debilitated, pregnant, or lactating pets. Do not use tramadol in conjunction with medications that decrease brain or lung function.

Are there any drug interactions I should be aware of?

The following medications should be used with caution when given with tramadol: antidepressants, azole antifungals, cimetidine, cyproheptadine, digoxin, ketamine, MAO inhibitors, metoclopramide, ondansetron, opioids, quinidine, SAMe, sevoflurane, SSRI and tricyclic antidepressants, warfarin, and yohimbine.

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.

Is there any monitoring that needs to be done with this medication?

There is no specific monitoring that needs to be done while your pet is taking this medication. Your veterinarian may monitor your pet to be sure that the medication is working. Monitor at home for adverse effects.

How do I store tramadol?

Tramadol tablets or capsules should be stored at room temperature around 25°C (77°F), away from moisture and light. Excursions in temperatures between 15°C to 30°C (59°F to 86°F) are permitted, but extreme heat and cold should be avoided.

Tramadol liquid preparations will likely need to be refrigerated, but always follow the storage recommendations on the product label.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. Signs of an adverse reaction or overdose of tramadol include seizures, incoordination, extreme sleepiness, agitation, or fast heartbeat. If your veterinarian is not available, follow their directions in contacting an emergency facility.

Evidence For Tramadol-Warfarin Interaction

Published: October 2006

This article is more than five years old. Some content may no
longer be current.

Prescriber Update 27(2): 23-24.

October 2006

Ruth Savage, Medical Assessor, CARM, New Zealand Pharmacovigilance
Centre, Dunedin

Local and international case reports provide evidence of an interaction
between oral tramadol and warfarin in some individuals, leading to an elevated
International Normalised Ratio (INR) and in some instances bruising or haemorrhage. 
The mechanism has not been determined.  The interaction usually occurs
3-4 days after tramadol is commenced in patients stabilised on warfarin. 
The decrease in INR after tramadol is withdrawn may take several days. 
Where it is necessary to prescribe tramadol with warfarin there should be
close monitoring of the INR, especially during the first week of treatment
with tramadol.

CARM reports show marked increases in INR

Up to 31 July 2006, the Centre for Adverse Reactions Monitoring (CARM)
had received a total of 116 reports of suspected adverse reactions to tramadol. 
Three of these reports were of increased International Normalised Ratio
(INR), ranging from 7.0 to 12.3 occurring when oral tramadol was given to
patients taking warfarin.  Two patients were symptomatic: one with
petechiae and one with melaena.  Onset time after tramadol was commenced
was one, two and seven days.  A fourth patient taking warfarin was
found to have bruising and a haematoma eight days after commencing tramadol.

The extent to which tramadol contributed to the elevated INR in the four
patients is not entirely clear as one patient may have taken an incorrect
dose of warfarin and the other three were also prescribed antibiotics. 
However, tramadol seemed the most likely cause in two of these cases.

Published case reports provide further evidence

Firmer evidence of an interaction with oral tramadol can be found in
two published case reports.^1,2 
A 76-year-old man had been on a stable dose of warfarin for six months when
he developed purpura and was found to have an INR of 7.3.  He had been
taking tramadol 50mg three times daily for one month.  There had been
no other changes to his prescribed medication, and he had not taken any
over-the-counter medicines.¹  A 61-year-old
woman on a stable regime of medicines including warfarin had recently finished
taking tramadol 50mg six hourly for two weeks.  She presented with
extensive bruising of the right upper arm, and was found to have an INR
of 10.6.  Warfarin was withheld for three days until her INR reduced
sufficiently for the warfarin to be reinstated, although initially a lower
dose was required.²

Similar reports in Australia

Case reports published in 2004 by the Australian Adverse Drug Reactions
Advisory Committee (ADRAC) detail 11 reports of elevated INR or haemorrhage
when tramadol was taken with warfarin. ³ 
The median onset time after addition of tramadol to stabilised warfarin
therapy was four (range 3-7) days, with the exception of one outlier at
six weeks.  Five reports described recovery within 1-4 days of tramadol
being discontinued, with or without reduction in the dose of warfarin. 
Two patients, aged 76 and 88 years, died of haemorrhagic stroke.

The interaction may occur in a sub-group of patients

In a pharmacodynamic study⁴ of the effect
of oral tramadol on INR in 19 patients stabilised on phenprocoumon (a coumarin
anticoagulant), two patients had clinically significant increases in INR
to 6.0 and 7.3, respectively, while taking tramadol.  However, the
mean difference in INR for all participants did not reach statistical significance. 
The mechanism of the interaction is unclear, but these results suggest that
the interaction may be associated with a variation in metabolism and that
only a sub-group of patients will be affected.   This possibility is
supported by the small number of case reports in the Australian database
compared with total prescriptions for oral tramadol.³

Increased INR monitoring necessary when tramadol prescribed
with warfarin

Although the mechanism has not been elucidated, there is evidence for
an interaction between oral tramadol and warfarin in some, but probably
not all, individuals.  The CARM case reports, where antibiotics were
also implicated, are a reminder that more than one interaction may be occurring. 
The interaction between tramadol and warfarin is documented in the product
information for tramadol.^5-7 
It is unclear whether the interaction occurs with injectable tramadol.³

Close monitoring of the INR should be undertaken when it is necessary
to prescribe tramadol for patients taking warfarin, especially during the
first week of treatment with tramadol.

Competing interests (author): none declared.

References

1. Scher ML, Huntington NH, Vitillo JA. Potential interaction
   between tramadol and warfarin. Ann Pharmacotherapy 1997;31:646-647.
2. Sabbe JR, Sims PJ, Sims MH. Tramadol-warfarin interaction.
   Pharmacotherapy 1998;18(4):871-873.
3. Adverse Drug Reactions Advisory Committee (ADRAC), Australia.
   Tramadol-warfarin interaction. ADRAC Bulletin 2004;23(4).
4. Boeijinga JK, van Meegan E, van den Ende R. Lack of interaction
   between tramadol and coumarins. J Clin Pharmacol 1998;38:966-970.
5. CSL (New Zealand) Limited. Tramal (tramadol) data sheet
   October 2005.
   www.medsafe.govt.nz/profs/Datasheet/t/TramalcapSRtabinjoraldrops.pdf
6. Pharmaco (NZ) Limited. Zytram BD (tramadol) data sheet
   20 February 2006. www.medsafe. govt.nz/profs/Datasheet/z/ZytramBDtab.pdf
7. AFT Pharmaceuticals Ltd. Tramadol data sheet 8 December
   2005. www.medsafe.govt.nz/profs/Datasheet/t/TramadolHydrochloridecap.pdf

Tramadol drug interactions with other drugs (compatibility) | Vidal.ru

Effects when used simultaneously with drugs
Naltrexone madol there is a significant decrease (up to a complete blockade) of the effects of the latter.
Fluvoxamine	Increased risk of seizures and serotonin syndrome.
Carbamazepine	Decreased plasma concentration of tramadol and its analgesic effect.
Antipsychotics	Increased risk of seizures.
Phenobarbital (barbiturates)	With the systematic use of barbiturates, especially phenobarbital, there is a possibility of a decrease in the analgesic effect of opioid analgesics. Long-term use of opioid analgesics or barbiturates stimulates the development of cross-tolerance.
Paroxetine	Cases of serotonin syndrome and seizures have been described.
Fluoxetine	Serotonin syndrome has been reported. Additive risk of seizures.
Citalopram and enantiomers	Increased risk of seizures. This combination should be avoided.
Lithium salt	Tramadol inhibits the reuptake of norepinephrine and serotonin and increases the release of serotonin. With the simultaneous use of tramadol and lithium preparations, there is a possibility of synergism of this effect. Patients require constant monitoring and, if necessary, correction of the dosing regimen of both drugs.
Flupentixol	Additive risk of convulsions and increased CNS depressant effect. This combination should be avoided.
Naloxone	Naloxone activates respiration, eliminating analgesia after the use of opioid analgesics (including fentanyl).
Serotonin reuptake inhibitors	Increased risk of seizures.
Anti-seizure drugs	Increased risk of seizures.
Warfarin	Increased anticoagulant effect of warfarin.
Olanzapine	Increased risk of increased inhibitory effect on the central nervous system, as well as seizures.
Pimozide	Additive CNS depressant effect and risk of seizures when tramadol is administered to patients receiving pimozide. This combination should be avoided.
Sulpiride	Increased risk of seizures. This combination should be avoided, especially in patients susceptible to seizures.
MAO inhibitors	Possible serotonin syndrome.
Serotonin reuptake inhibitors, tricyclic antidepressants, antipsychotics, other drugs that lower the seizure threshold	Increased risk of seizures. Leave a Reply Cancel reply Your email address will not be published. Required fields are marked * Comment * Name * Email * Website