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Tramadol tabs: tramadol oral Interactions with Other Medication

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Tramadol (Oral Route) Description and Brand Names

Description and Brand Names

Drug information provided by: IBM Micromedex

US Brand Name

  1. ConZip
  2. FusePaq Synapryn
  3. Rybix ODT
  4. Ryzolt
  5. Ultram
  6. Ultram ER

Descriptions

Tramadol is used to relieve moderate to moderately severe pain, including pain after surgery. The extended-release capsules or tablets are used for chronic ongoing pain.

Tramadol belongs to the group of medicines called opioid analgesics. It acts in the central nervous system (CNS) to relieve pain.

When tramadol is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

This medicine is available only under a restricted distribution program called the Opioid Analgesic REMS (Risk Evaluation and Mitigation Strategy) program.

This product is available in the following dosage forms:

  • Capsule, Extended Release
  • Solution
  • Tablet
  • Tablet, Extended Release
  • Capsule, Extended Release, 24 HR
  • Suspension

 

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Portions of this document last updated: Oct. 01, 2021

Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.


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Tramadol 50 mg capsules – Summary of Product Characteristics (SmPC)

This information is intended for use by health professionals

Tramadol 50 mg capsules, hard

Each hard capsule contains 50 mg tramadol hydrochloride.

For the full list of excipients, see section 6.1.

Capsule, hard

Green/ Yellow, size ‘4’ hard gelatin capsules filled with white to off-white powder and imprinted with ‘T’ on green cap and ’02’ on yellow body with black ink.

Treatment of moderate to severe pain.

Posology

The dose should be adjusted to the intensity of the pain and the sensitivity of the individual patient. The lowest effective dose for analgesia should generally be selected.

Unless otherwise prescribed, Tramadol should be administered as follows:

Adults and children aged 12 years and over

Oral administration

Acute pain: An initial dose is 50-100 mg depending on the intensity of pain. This can be followed by doses of 50 or 100 mg 4-6 hours later, and duration of therapy should be matched to clinical need (see section 5.1) . A total daily dose of 400 mg should not be exceeded except in special clinical circumstances.

Pain associated with chronic conditions: Use an initial dose of 50 mg and then titrate dose according to pain severity. The initial dose may be followed if necessary by 50-100 mg every 4-6 hours. The recommended doses are intended as a guideline. Patients should always receive the lowest dose that provides effective pain control. A total daily dose of 400 mg should not be exceeded except in special clinical circumstances. The need for continued treatment should be assessed at regular intervals as withdrawal symptoms and dependence have been reported (see section 4. 4).

The capsules are to be taken whole, not divided or chewed, with sufficient liquid, independent of meals.

Tramadol should under no circumstances be administered for longer than absolutely necessary. If long-term pain treatment with tramadol is necessary in view of the nature and severity of the illness, then careful and regular monitoring should be carried out (if necessary with breaks in treatment) to establish whether and to what extent further treatment is necessary.

Children

Tramadol capsules are not suitable for children below the age of 12 years.

Geriatric patients

A dose adjustment is not usually necessary in patients up to 75 years without clinically manifest hepatic or renal insufficiency. In elderly patients over 75 years elimination may be prolonged. Therefore, if necessary the dosage interval is to be extended according to the patient’s requirements.

Renal insufficiency/Dialysis and hepatic impairment

In patients with renal and/or hepatic insufficiency the elimination of tramadol is delayed. In these patients prolongation of the dosage intervals should be carefully considered according to the patient’s requirements. In cases of severe renal and/or severe hepatic insufficiency tramadol are not recommended.

Tramadol is contraindicated:

– in hypersensitivity to tramadol hydrochloride or to any of the excipients listed in section 6.1..

– in acute intoxication with alcohol, hypnotics, analgesics, opioids, or psychotropic medicinal products,

– in patients who are receiving MAO inhibitors or who have taken them within the last 14 days (see section 4.5),

– in patients with epilepsy not adequately controlled by treatment,

– for use in narcotic withdrawal treatment.

Tramadol may only be used with particular caution in opioid-dependent patients, patients with head injury, shock, a reduced level of consciousness of uncertain origin, disorders of the respiratory centre or function, increased intracranial pressure.

In patients sensitive to opiates the product should only be used with caution.

Care should be taken when treating patients with respiratory depression, or if concomitant CNS depressant drugs are being administered (see section 4.5), or if the recommended dosage is significantly exceeded (see section 4.9) as the possibility of respiratory depression cannot be excluded in these situations.

Convulsions have been reported in patients receiving tramadol at the recommended dose levels. The risk may be increased when doses of tramadol exceed the recommended upper daily dose limit (400 mg). In addition, tramadol may increase the seizure risk in patients taking other medicinal products that lowers the seizure threshold (see section 4.5). Patients with epilepsy or those susceptible to seizures should be only treated with tramadol if there are compelling circumstances.

Tolerance, psychic and physical dependence may develop, especially after long-term use. In patients with a tendency to drug abuse or dependence, treatment with Tramadol should only be carried out for short periods under strict medical supervision.

When a patient no longer requires therapy with tramadol, it may be advisable to taper the dose gradually to prevent symptoms of withdrawal.

Tramadol is not suitable as a substitute in opioid-dependent patients. Although it is an opioid agonist, tramadol cannot suppress morphine withdrawal symptoms.

Tramadol should be used with caution in patients with impaired hepatic and renal function (see section 4.2).



CYP2D6 metabolism

Tramadol is metabolised by the liver enzyme CYP2D6. If a patient has a deficiency or is completely lacking this enzyme an adequate analgesic effect may not be obtained. Estimates indicate that up to 7% of the Caucasian population may have this deficiency. However, if the patient is an ultra-rapid metaboliser there is a risk of developing <side effects> of opioid toxicity even at commonly prescribed doses.

General symptoms of opioid toxicity include confusion, somnolence, shallow breathing, small pupils, nausea, vomiting, constipation and lack of appetite. In severe cases this may include symptoms of circulatory and respiratory depression, which may be life threatening and very rarely fatal. Estimates of prevalence of ultra-rapid metabolisers in different populations are summarised below:

Population

African/Ethiopian

African American

Asian

Caucasian

Greek

Hungarian

Northern European

Prevalence %

29%

3.4% to 6.5%

1.2% to 2%

3.6% to 6.5%

6.0%

1.9%

1% to 2%



Post-operative use in children

There have been reports in the published literature that tramadol given post-operatively in children after tonsillectomy and/or adenoidectomy for obstructive sleep apnoea, led to rare, but life threatening adverse events. Extreme caution should be exercised when tramadol is administered to children for post-operative pain relief and should be accompanied by close monitoring for symptoms of opioid toxicity including respiratory depression.



Children with compromised respiratory function

Tramadol is not recommended for use in children in whom respiratory function might be compromised including neuromuscular disorders, severe cardiac or respiratory conditions, upper respiratory or lung infections, multiple trauma or extensive surgical procedures. <These factors may worsen symptoms of opioid toxicity>.

Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs:

Concomitant use of Tramadol and sedative medicines such as benzodiazepines or related drugs may result in sedation, respiratory depression, coma and death. Because of these risks, concomitant prescribing with these sedative medicines should be reserved for patients for whom alternative treatment options are not possible. If a decision is made to prescribe Tramadol concomitantly with sedative medicines, the lowest effective dose should be used, and the duration of treatment should be as short as possible.

The patients should be followed closely for signs and symptoms of respiratory depression and sedation. In this respect, it is strongly recommended to inform patients and their caregivers to be aware of these symptoms (see section 4.5).


Sleep-related breathing disorders

Opioids can cause sleep-related breathing disorders including central sleep apnoea (CSA) and sleep-related hypoxemia. Opioid use increases the risk of CSA in a dose-dependent fashion. In patients who present with CSA, consider decreasing the total opioid dosage.


Adrenal insufficiency

Opioid analgesics may occasionally cause reversible adrenal insufficiency requiring monitoring and glucocorticoid replacement therapy. Symptoms of acute or chronic adrenal insufficiency may include e. g. severe abdominal pain, nausea and vomiting, low blood pressure, extreme fatigue, decreased appetite, and weight loss.


Serotonin syndrome

Serotonin syndrome, a potentially life-threatening condition, has been reported in patients receiving tramadol in combination with other serotonergic agents or tramadol alone (see sections 4.5, 4.8 and 4.9).

If concomitant treatment with other serotonergic agents is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose escalations.

Symptoms of serotonin syndrome may include mental status changes, autonomic instability, neuromuscular abnormalities and/or gastrointestinal symptoms.

If serotonin syndrome is suspected, a dose reduction or discontinuation of therapy should be considered depending on the severity of the symptoms. Withdrawal of the serotonergic drugs usually brings about a rapid improvement.

Excipients:

Sodium

Tramadol capsules contains Sodium. This medicine contains less than 1 mmol sodium (23 mg) per capsule, that is to say essentially ‘sodium-free’.

Tramadol should not be combined with MAO inhibitors (see section 4.3).

In patients treated with MAO inhibitors in the 14 days prior to the use of the opioid pethidine, life threatening interactions on the central nervous system, respiratory and cardiovascular function have been observed. The same interactions with MAO inhibitors cannot be ruled out during treatment with tramadol.

Concomitant administration of tramadol with other centrally depressant medicinal products including alcohol may potentiate the CNS effects (see section 4.8).

The results of pharmacokinetic studies have so far shown that on the concomitant or previous administration of cimetidine (enzyme inhibitor) clinically relevant interactions are unlikely to occur. Simultaneous or previous administration of carbamazepine (enzyme inducer) may reduce the analgesic effect and shorten the duration of action.

The combination with mixed agonist/antagonists (e.g. buprenorphine, nalbuphine, pentazocine) and tramadol is not advisable, because the analgesic effect of a pure agonist may be theoretically reduced in such circumstances.

Tramadol can induce convulsions and increase the potential for selective serotonin re-uptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic anti-depressants, anti-psychotics and other seizure threshold lowering medicinal products (such as bupropion, mirtazapine, tetrahydrocannabinol) to cause convulsions.

• Concomitant therapeutic use of tramadol and serotonergic drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), MAO inhibitors (see section 4.3), tricyclic antidepressants and mirtazapine serotonin syndrome, a potentially life-threatening condition (see sections 4.4 and 4.8).

Caution should be exercised during concomitant treatment with tramadol and coumarin derivatives (e. g. warfarin) due to reports of increased INR with major bleeding and ecchymoses in some patients.

Other medicinal products known to inhibit CYP3A4, such as ketoconazole, ritonavir and erythromycin, might inhibit the metabolism of tramadol (N-demethylation) and probably also the metabolism of the active O-demethylated metabolite. The clinical importance of such an interaction has not been studied (see section 4.8).

In a limited number of studies the pre- or postoperative application of the antiemetic 5-HT3 antagonist ondansetron increased the requirement of tramadol in patients with postoperative pain.

Sedative medicines such as benzodiazepines or related drugs:

The concomitant use of opioids with sedative medicines such as benzodiazepines or related drugs increases the risk of sedation, respiratory depression, coma and death because of additive CNS depressant effect. The dose and duration of concomitant use should be limited (see section 4.4).

Pregnancy

Animal studies with tramadol revealed at very high doses effects on organ development, ossification and neonatal mortality. Teratogenic effects were not observed. Tramadol crosses the placenta. There is inadequate evidence available on the safety of tramadol in human pregnancy. Therefore tramadol should not be used in pregnant women.

Tramadol – administered before or during birth – does not affect uterine contractility. In new-born infants it may induce changes in the respiratory rate which are usually not clinically relevant. Chronic use during pregnancy may lead to neonatal withdrawal symptoms.


Breast-feeding

Approximately 0.1% of the maternal dose of tramadol is excreted in breast milk. In the immediate post-partum period, for maternal oral daily dosage up to 400 mg, this corresponds to a mean amount of tramadol ingested by breast-fed infants of 3% of the maternal weight-adjusted dosage. For this reason tramadol should not be used during lactation or alternatively, breast-feeding should be discontinued during treatment with tramadol. Discontinuation of breast-feeding is generally not necessary following a single dose of tramadol.

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Even when taken according to instructions, Tramadol may cause effects such as somnolence and dizziness and therefore may impair the reactions of drivers and machine operators. This applies particularly in conjunction with alcohol and other psychotropic substances.

The undesirable effects are classified into system organ classes and their frequency is classified as follows: Very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000) and not known (cannot be estimated from the available data).

The most commonly reported adverse reactions are nausea and dizziness, both occurring in more than 10% of patients.


Metabolism and nutrition disorders

Not known: hypoglycaemia


Psychiatric disorders

Rare: Hallucinations, confusion, sleep disturbance, anxiety and nightmares. Psychic side-effects may occur following administration of tramadol, which vary individually in intensity and nature (depending on personality and duration of medication). These include changes in mood (usually elation, occasionally dysphoria), changes in activity (mostly reduced, occasionally increased) and changes in cognitive and sensorial ability (e.g. decision behaviour, perception disorders). Dependence may occur.


Nervous system disorders

Very common: Dizziness.

Common: Headache, somnolence.

Rare: Changes in appetite, paraesthesia, tremor, respiratory depression, epileptiform convulsions, abnormal coordination, involuntary muscle contractions, syncope.

If the recommended doses are considerably exceeded and other centrally depressant substances are administered concomitantly (see section 4.5), respiratory depression may occur.

Epileptiform convulsions occurred mainly after administration of high doses of tramadol or after concomitant treatment with medicinal products which can lower the seizure threshold (see sections 4.4 and 4.5).

Not known: speech disorders, serotonin syndrome


Eye disorders

Rare: Blurred vision.


Cardiac disorders

Uncommon:Cardiovascular regulation (palpitations, tachycardia, postural hypotension or cardiovascular collapse). These adverse effects may occur especially in connection with intravenous administration and if the patient is experiencing physical stress.

Rare: Bradycardia, increased blood pressure.


Respiratory, thoracic and mediastinal disorders

Rare: Dyspnoea

Frequency not known: Worsening of asthma has been reported, though a causal relationship has not been established, Hiccups.


Gastrointestinal disorders

Very common: Nausea.

Common: Vomiting, constipation, dry mouth.

Uncommon: Retching; gastrointestinal irritation (a feeling of pressure in the stomach, bloating), diarrhoea.


Hepatobiliary disorders

Frequency not known: In a few isolated cases an increase in liver enzyme values has been reported in a temporal connection with the therapeutic use of tramadol.


Skin and subcutaneous tissue disorders

Common: Sweating.

Uncommon: Dermal reactions (e.g. pruritus, rash, urticaria).


Musculoskeletal and connective tissue disorders

Rare: Motorial weakness.


Renal and urinary disorders

Rare: Micturition disorders (difficulty in passing urine and urinary retention).


General disorders

Common: fatigue

Rare: Allergic reactions (e.g. dyspnoea, bronchospasm, wheezing, angioneurotic oedema) and anaphylaxis; symptoms of withdrawal reactions, similar to those occurring during opiate withdrawal, may occur as follows: agitation, anxiety, nervousness, insomnia, hyperkinesia, tremor and gastrointestinal symptoms.

Other symptoms that have very rarely been seen with tramadol discontinuation include: panic attacks, severe anxiety, hallucinations, paraesthesias, tinnitus and unusual CNS symptoms (i.e. confusion, delusions, depersonalization, derealization, paranoia).

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Symptoms

In principle, on intoxication with tramadol symptoms similar to those of other centrally acting analgesics (opioids) are to be expected. These include in particular miosis, vomiting, cardiovascular collapse, consciousness disorders up to coma, convulsions and respiratory depression up to respiratory arrest.

Serotonin syndrome has also been reported.

Treatment

The general emergency measures apply. Keep open the respiratory tract (aspiration), maintain respiration and circulation depending on the symptoms. The stomach is to be emptied by vomiting (conscious patient) or gastric irrigation. The antidote for respiratory depression is naloxone. In animal experiments naloxone had no effect on convulsions. In such cases diazepam should be given intravenously.

Tramadol is minimally eliminated from the serum by haemodialysis or haemo-filtration. Therefore treatment of acute intoxication with tramadol with haemodialysis or haemofiltration alone is not suitable for detoxification.

Pharmacotherapeutic group: Analgesics, other opioids, ATC code: N02AX02.

Tramadol is a centrally acting opioid analgesic. It is a non selective pure agonist at μ-, δ- and κ-opioid receptors with a higher affinity for the μ-receptor. Other mechanisms which may contribute to its analgesic effect are inhibition of neuronal reuptake of noradrenaline and enhancement of serotonin release.

Tramadol has an antitussive effect. In contrast to morphine, analgesic doses of tramadol over a wide range have no respiratory depressant effect. Also gastrointestinal motility is less affected. Effects on the cardiovascular system tend to be slight. The potency of tramadol is reported to be 1/10 (one tenth) to 1/6 (one sixth) that of morphine.

Paediatric population

Effects of enteral and parenteral administration of tramadol have been investigated in clinical trials involving more than 2000 paediatric patients ranging in age from neonate to 17 years of age. The indications for pain treatment studied in those trials included pain after surgery (mainly abdominal), after surgical tooth extractions, due to fractures, burns and traumas as well as other painful conditions likely to require analgesic treatment for at least 7 days.

At single doses of up to 2 mg/kg or multiple doses of up to 8 mg/kg per day (to a maximum of 400 mg per day) efficacy of tramadol was found to be superior to placebo, and superior or equal to paracetamol, nalbuphine, pethidine or low dose morphine. The conducted trials confirmed the efficacy of tramadol. The safety profile of tramadol was similar in adult and paediatric patients older than 1 year (see section 4.2).

More than 90% of tramadol is absorbed after oral administration. The mean absolute bioavailability is approximately 70 %, irrespective of the concomitant intake of food. The difference between absorbed and non-metabolised available tramadol is probably due to the low first-pass effect. The first-pass effect after oral administration is a maximum of 30 %.

Tramadol has a high tissue affinity (V d,ß = 203 + 40 l). It has a plasma protein binding of about 20 %.

Following a single oral dose administration of tramadol 100 mg as capsules or tablets to young healthy volunteers, plasma concentrations were detectable within approximately 15 to 45 minutes within a mean Cmax of 280 to 208 mcg/L and Tmax of 1.6 to 2h.

Tramadol passes the blood-brain and placental barriers. Very small amounts of the substance and its Odesmethyl derivative are found in the breast-milk (0.1 % and 0.02 % respectively of the applied dose).

Elimination half-life t1/2,ß is approximately 6 h, irrespective of the mode of administration. In patients above 75 years of age it may be prolonged by a factor of approximately 1.4.

In humans tramadol is mainly metabolised by means of N- and O-demethylation and conjugation of the Odemethylation products with glucuronic acid. Only O-desmethyltramadol is pharmacologically active. There are considerable interindividual quantitative differences between the other metabolites. So far, eleven metabolites have been found in the urine. Animal experiments have shown that O-desmethyltramadol is more potent than the parent substance by the factor 2 – 4. Its half-life t1/2,ß (6 healthy volunteers) is 7.9 h (range 5.4 – 9.6 h) and is approximately that of tramadol.

The inhibition of one or both types of the isoenzymes CYP3A4 and CYP2D6 involved in the biotransformation of tramadol may affect the plasma concentration of tramadol or its active metabolite.

Tramadol and its metabolites are almost completely excreted via the kidneys. Cumulative urinary excretion is 90 % of the total radioactivity of the administered dose. In cases of impaired hepatic and renal function the half-life may be slightly prolonged. In patients with cirrhosis of the liver, elimination half-lives of 13.3 + 4.9 h (tramadol) and 18.5 + 9.4 h (O-desmethyltramadol), in an extreme case 22.3 h and 36 h respectively, have been determined. In patients with renal insufficiency (creatinine clearance < 5 ml/min) the values were 11 + 3.2 h and 16.9 + 3 h, in an extreme case 19.5 h and 43.2 h respectively.

Tramadol has a linear pharmacokinetic profile within the therapeutic dosage range.

The relationship between serum concentrations and the analgesic effect is dose-dependent, but varies considerably in isolated cases. A serum concentration of 100 – 300 ng/ml is usually effective.

Paediatric population

The pharmacokinetics of tramadol and O-desmethyltramadol after single-dose and multiple-dose oral administration to subjects aged 1 year to 16 years were found to be generally similar to those in adults when adjusting for dose by body weight, but with a higher between-subject variability in children aged 8 years and below.

In children below 1 year of age, the pharmacokinetics of tramadol and O-desmethyltramadol have been investigated, but have not been fully characterized. Information from studies including this age group indicates that the formation rate of O-desmethyltramadol via CYP2D6 increases continuously in neonates, and adult levels of CYP2D6 activity are assumed to be reached at about 1 year of age. In addition, immature glucuronidation systems and immature renal function may result in slow elimination and accumulation of O-desmethyltramadol in children under 1 year of age.

On repeated oral and parenteral administration of tramadol for 6 – 26 weeks in rats and dogs and oral administration for 12 months in dogs, haematological, clinico-chemical and histological investigations showed no evidence of any substance-related changes. Central nervous manifestations only occurred after high doses considerably above the therapeutic range: restlessness, salivation, convulsions, and reduced weight gain. Rats and dogs tolerated oral doses of 20 mg/kg and 10 mg/kg body weight respectively, and dogs rectal doses of 20 mg/kg body weight without any reactions.

In rats tramadol dosages from 50 mg/kg/day upwards caused toxic effects in dams and raised neonate mortality. In the offspring retardation occurred in the form of ossification disorders and delayed vaginal and eye opening. Male fertility was not affected. After higher doses (from 50 mg/kg/day upwards) females exhibited a reduced pregnancy rate. In rabbits there were toxic effects in dams from 125 mg/kg upwards and skeletal anomalies in the offspring.

In some in-vitro test systems there was evidence of mutagenic effects. In-vivo studies showed no such effects. According to knowledge gained so far, tramadol can be classified as non-mutagenic.

Studies on the tumorigenic potential of tramadol hydrochloride have been carried out in rats and mice. The study in rats showed no evidence of any substance-related increase in the incidence of tumours. In the study in mice there was an increased incidence of liver cell adenomas in male animals (a dose-dependent, nonsignificant increase from 15 mg/kg upwards) and an increase in pulmonary tumours in females of all dosage groups (significant, but not dose-dependent).


Contents of capsule

Cellulose, microcrystalline

Silica, colloidal anhydrous

Sodium starch glycolate (Type A)

Magnesium stearate


Capsule shell:


Body

Gelatin

Sodium lauryl sulphate

Iron oxide yellow (E172)

Titanium dioxide (E171)


Cap

Gelatin

Sodium lauryl sulphate

Indigo carmine

Iron oxide yellow (E172)

Titanium dioxide (E171)


Printing ink:

Shellac

Black iron oxide (E172)

PVC/PVDC/Aluminium foil blister: 10, 20, 30, 50, 60, 90, 100 and 500 Capsules

HDPE bottle pack with polypropyle closure:
30,200 and 500 Capsules

Not all pack sizes may be marketed.

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.

Milpharm Limited

Ares Block, Odyssey Business Park

West End Road

Ruislip HA4 6QD

United Kingdom

Ultram, ConZip (tramadol) dosing, indications, interactions, adverse effects, and more

  • 5-HTP

    Monitor Closely (1)5-HTP and tramadol both increase serotonin levels. Use Caution/Monitor.

  • abametapir

    Serious – Use Alternative (1)abametapir will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

  • abiraterone

    Monitor Closely (1)abiraterone increases levels of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider increasing tramadol dose if clinically appropriate; if abiraterone is discontinued, consider reducing tramadol dose and frequently monitor for signs of respiratory depression and sedation.

  • albuterol

    Monitor Closely (1)tramadol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • alfentanil

    Monitor Closely (1)alfentanil and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, alfentanil. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • almotriptan

    Monitor Closely (1)almotriptan and tramadol both increase serotonin levels. Use Caution/Monitor.

  • alprazolam

    Monitor Closely (1)alprazolam and tramadol both increase sedation. Use Caution/Monitor.

  • alvimopan

    Contraindicated (1)alvimopan, tramadol. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

  • amifampridine

    Monitor Closely (1)tramadol increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely.
    Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

  • amiodarone

    Monitor Closely (2)amiodarone decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

    amiodarone decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

  • amitriptyline

    Monitor Closely (2)amitriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and amitriptyline both increase sedation. Use Caution/Monitor.

  • amobarbital

    Monitor Closely (1)amobarbital and tramadol both increase sedation. Use Caution/Monitor.

  • amoxapine

    Monitor Closely (2)amoxapine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and amoxapine both increase sedation. Use Caution/Monitor.

  • apalutamide

    Serious – Use Alternative (1)apalutamide will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

  • apomorphine

    Monitor Closely (1)tramadol and apomorphine both increase sedation. Use Caution/Monitor.

  • arformoterol

    Monitor Closely (1)tramadol increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • aripiprazole

    Monitor Closely (1)tramadol and aripiprazole both increase sedation. Use Caution/Monitor.

  • armodafinil

    Monitor Closely (1)tramadol increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • artemether/lumefantrine

    Monitor Closely (1)artemether/lumefantrine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

  • asenapine

    Minor (1)asenapine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

  • atazanavir

    Monitor Closely (1)atazanavir increases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

  • azelastine

    Monitor Closely (1)azelastine and tramadol both increase sedation. Use Caution/Monitor.

  • baclofen

    Monitor Closely (1)baclofen and tramadol both increase sedation. Use Caution/Monitor.

  • belladonna and opium

    Monitor Closely (1)belladonna and opium and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • benperidol

    Monitor Closely (1)tramadol and benperidol both increase sedation. Use Caution/Monitor.

  • benzhydrocodone/acetaminophen

    Serious – Use Alternative (1)benzhydrocodone/acetaminophen, tramadol.
    Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

  • benzphetamine

    Monitor Closely (1)tramadol increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • bosentan

    Monitor Closely (1)bosentan will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • bremelanotide

    Serious – Use Alternative (1)bremelanotide will decrease the level or effect of tramadol by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

  • brexanolone

    Monitor Closely (1)brexanolone, tramadol.
    Either increases toxicity of the other by sedation. Use Caution/Monitor.

  • brimonidine

    Minor (1)brimonidine increases effects of tramadol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

  • brompheniramine

    Monitor Closely (1)brompheniramine and tramadol both increase sedation. Use Caution/Monitor.

  • buprenorphine

    Monitor Closely (1)buprenorphine and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (2)tramadol, buprenorphine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

    buprenorphine, tramadol. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

  • buprenorphine buccal

    Monitor Closely (1)buprenorphine buccal and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (2)buprenorphine buccal, tramadol. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

    tramadol, buprenorphine buccal. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • buprenorphine, long-acting injection

    Monitor Closely (1)tramadol increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

  • bupropion

    Monitor Closely (1)bupropion will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

  • buspirone

    Monitor Closely (1)buspirone and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • butabarbital

    Monitor Closely (1)butabarbital and tramadol both increase sedation. Use Caution/Monitor.

  • butalbital

    Monitor Closely (1)butalbital and tramadol both increase sedation. Use Caution/Monitor.

  • butorphanol

    Monitor Closely (1)butorphanol and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (2)tramadol, butorphanol. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

    butorphanol, tramadol. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

  • caffeine

    Monitor Closely (1)tramadol increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • calcium/magnesium/potassium/sodium oxybates

    Serious – Use Alternative (1)tramadol, calcium/magnesium/potassium/sodium oxybates.
    Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

  • carbamazepine

    Monitor Closely (1)carbamazepine will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • carbinoxamine

    Monitor Closely (1)carbinoxamine and tramadol both increase sedation. Use Caution/Monitor.

  • carisoprodol

    Monitor Closely (1)carisoprodol and tramadol both increase sedation. Use Caution/Monitor.

  • celecoxib

    Monitor Closely (2)celecoxib decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

    celecoxib decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

  • cenobamate

    Monitor Closely (1)cenobamate, tramadol.
    Either increases effects of the other by sedation. Use Caution/Monitor.

  • chloral hydrate

    Monitor Closely (1)chloral hydrate and tramadol both increase sedation. Use Caution/Monitor.

  • chlordiazepoxide

    Monitor Closely (1)chlordiazepoxide and tramadol both increase sedation. Use Caution/Monitor.

  • chloroquine

    Monitor Closely (2)chloroquine decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

    chloroquine decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

  • chlorpheniramine

    Monitor Closely (1)chlorpheniramine and tramadol both increase sedation. Use Caution/Monitor.

  • chlorpromazine

    Monitor Closely (1)tramadol and chlorpromazine both increase sedation. Use Caution/Monitor.

  • chlorzoxazone

    Monitor Closely (1)chlorzoxazone and tramadol both increase sedation. Use Caution/Monitor.

  • cimetidine

    Monitor Closely (2)cimetidine decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

    cimetidine decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

  • cinnarizine

    Monitor Closely (1)cinnarizine and tramadol both increase sedation. Use Caution/Monitor.

  • citalopram

    Monitor Closely (1)citalopram and tramadol both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

  • clarithromycin

    Monitor Closely (1)clarithromycin will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • clemastine

    Monitor Closely (1)clemastine and tramadol both increase sedation. Use Caution/Monitor.

  • clobazam

    Monitor Closely (2)clobazam will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.

    tramadol, clobazam. Other (see comment). Use Caution/Monitor.
    Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

  • clomipramine

    Monitor Closely (2)clomipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and clomipramine both increase sedation. Use Caution/Monitor.

  • clonazepam

    Monitor Closely (1)clonazepam and tramadol both increase sedation. Use Caution/Monitor.

  • clonidine

    Serious – Use Alternative (1)clonidine, tramadol.
    Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

  • clorazepate

    Monitor Closely (1)clorazepate and tramadol both increase sedation. Use Caution/Monitor.

  • clozapine

    Monitor Closely (1)tramadol and clozapine both increase sedation. Use Caution/Monitor.

  • cobicistat

    Monitor Closely (2)cobicistat will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. A decreased dose of tramadol may be required

    cobicistat will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. A decreased dose of tramadol may be required

  • cocaine

    Monitor Closely (1)cocaine and tramadol both increase serotonin levels. Use Caution/Monitor.

  • codeine

    Monitor Closely (1)codeine and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, codeine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • crizotinib

    Monitor Closely (1)crizotinib increases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.

  • crofelemer

    Monitor Closely (1)crofelemer increases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

  • cyclizine

    Monitor Closely (1)cyclizine and tramadol both increase sedation. Use Caution/Monitor.

  • cyclobenzaprine

    Monitor Closely (1)cyclobenzaprine and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

  • cyproheptadine

    Monitor Closely (1)cyproheptadine and tramadol both increase sedation. Use Caution/Monitor.

  • dabrafenib

    Monitor Closely (1)dabrafenib will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • dacomitinib

    Serious – Use Alternative (1)dacomitinib will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

  • dantrolene

    Monitor Closely (1)dantrolene and tramadol both increase sedation. Use Caution/Monitor.

  • darifenacin

    Minor (1)darifenacin will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

  • darunavir

    Monitor Closely (1)darunavir will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. A decreased dose of tramadol may be required

  • desflurane

    Monitor Closely (1)desflurane and tramadol both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

  • desipramine

    Monitor Closely (2)desipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and desipramine both increase sedation. Use Caution/Monitor.

  • desvenlafaxine

    Monitor Closely (1)desvenlafaxine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses Serious – Use Alternative (1)tramadol and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

  • deutetrabenazine

    Monitor Closely (1)tramadol and deutetrabenazine both increase sedation. Use Caution/Monitor.

  • dexamethasone

    Monitor Closely (1)dexamethasone will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • dexchlorpheniramine

    Monitor Closely (1)dexchlorpheniramine and tramadol both increase sedation. Use Caution/Monitor.

  • dexfenfluramine

    Monitor Closely (2)tramadol increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

    dexfenfluramine and tramadol both increase serotonin levels. Use Caution/Monitor.

  • dexmedetomidine

    Monitor Closely (1)dexmedetomidine and tramadol both increase sedation. Use Caution/Monitor.

  • dexmethylphenidate

    Monitor Closely (1)tramadol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dextroamphetamine

    Monitor Closely (2)tramadol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

    dextroamphetamine and tramadol both increase serotonin levels. Use Caution/Monitor.Minor (1)dextroamphetamine increases effects of tramadol by unspecified interaction mechanism. Minor/Significance Unknown.

  • dextromethorphan

    Monitor Closely (1)dextromethorphan and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • dextromoramide

    Monitor Closely (1)dextromoramide and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, dextromoramide. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • diamorphine

    Monitor Closely (1)diamorphine and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, diamorphine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • diazepam

    Monitor Closely (1)diazepam and tramadol both increase sedation. Use Caution/Monitor.

  • diazepam intranasal

    Serious – Use Alternative (1)diazepam intranasal, tramadol.
    Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

  • diethylpropion

    Monitor Closely (1)tramadol increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • difenoxin hcl

    Monitor Closely (1)difenoxin hcl and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, difenoxin hcl. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • dihydroergotamine

    Monitor Closely (1)dihydroergotamine and tramadol both increase serotonin levels. Use Caution/Monitor.

  • dihydroergotamine intranasal

    Monitor Closely (1)dihydroergotamine intranasal and tramadol both increase serotonin levels. Use Caution/Monitor.

  • dimenhydrinate

    Monitor Closely (1)dimenhydrinate and tramadol both increase sedation. Use Caution/Monitor.

  • diphenhydramine

    Monitor Closely (3)diphenhydramine decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

    diphenhydramine and tramadol both increase sedation. Use Caution/Monitor.

    diphenhydramine decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

  • diphenoxylate hcl

    Monitor Closely (1)diphenoxylate hcl and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, diphenoxylate hcl. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • dipipanone

    Monitor Closely (1)dipipanone and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, dipipanone. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • dobutamine

    Monitor Closely (1)tramadol increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dopamine

    Monitor Closely (1)tramadol increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dopexamine

    Monitor Closely (1)tramadol increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dosulepin

    Monitor Closely (1)tramadol and dosulepin both increase sedation. Use Caution/Monitor.

  • doxepin

    Monitor Closely (2)doxepin and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and doxepin both increase sedation. Use Caution/Monitor.

  • doxylamine

    Monitor Closely (1)doxylamine and tramadol both increase sedation. Use Caution/Monitor.

  • dronedarone

    Minor (1)dronedarone will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

  • droperidol

    Monitor Closely (1)tramadol and droperidol both increase sedation. Use Caution/Monitor.

  • duloxetine

    Monitor Closely (1)duloxetine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.Serious – Use Alternative (1)duloxetine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

  • efavirenz

    Monitor Closely (1)efavirenz will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • elagolix

    Monitor Closely (1)elagolix decreases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

  • eletriptan

    Monitor Closely (1)eletriptan and tramadol both increase serotonin levels. Use Caution/Monitor.

  • eliglustat

    Monitor Closely (1)eliglustat increases levels of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

  • eluxadoline

    Serious – Use Alternative (1)tramadol, eluxadoline.
    Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .

  • elvitegravir/cobicistat/emtricitabine/tenofovir DF

    Monitor Closely (2)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

    elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

  • encorafenib

    Monitor Closely (1)encorafenib, tramadol. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

  • enzalutamide

    Monitor Closely (1)enzalutamide will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • ephedrine

    Monitor Closely (1)tramadol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • epinephrine

    Monitor Closely (1)tramadol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • epinephrine racemic

    Monitor Closely (1)tramadol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • ergotamine

    Monitor Closely (1)ergotamine and tramadol both increase serotonin levels. Use Caution/Monitor.

  • erythromycin base

    Monitor Closely (1)erythromycin base will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May require decreased tramadol dose or adjustment of dosing interval; increased risk for serious adverse events including seizures and serotonin syndrome

  • erythromycin ethylsuccinate

    Monitor Closely (1)erythromycin ethylsuccinate will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May require decreased tramadol dose or adjustment of dosing interval; increased risk for serious adverse events including seizures and serotonin syndrome

  • erythromycin lactobionate

    Monitor Closely (1)erythromycin lactobionate will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May require decreased tramadol dose or adjustment of dosing interval; increased risk for serious adverse events including seizures and serotonin syndrome

  • erythromycin stearate

    Monitor Closely (1)erythromycin stearate will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May require decreased tramadol dose or adjustment of dosing interval; increased risk for serious adverse events including seizures and serotonin syndrome

  • escitalopram

    Monitor Closely (1)escitalopram and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • esketamine intranasal

    Monitor Closely (1)esketamine intranasal, tramadol.
    Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

  • eslicarbazepine acetate

    Monitor Closely (1)eslicarbazepine acetate will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • estazolam

    Monitor Closely (1)estazolam and tramadol both increase sedation. Use Caution/Monitor.

  • ethanol

    Monitor Closely (1)tramadol and ethanol both increase sedation. Use Caution/Monitor.

  • etomidate

    Monitor Closely (1)etomidate and tramadol both increase sedation. Use Caution/Monitor.

  • etravirine

    Monitor Closely (1)etravirine will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • eucalyptus

    Minor (1)tramadol and eucalyptus both increase sedation. Minor/Significance Unknown.

  • fedratinib

    Monitor Closely (1)fedratinib will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

  • fenfluramine

    Monitor Closely (2)tramadol increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

    fenfluramine and tramadol both increase serotonin levels. Use Caution/Monitor.

  • fentanyl

    Serious – Use Alternative (1)fentanyl, tramadol.
    Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

  • fentanyl intranasal

    Serious – Use Alternative (1)fentanyl intranasal, tramadol.
    Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

  • fentanyl transdermal

    Serious – Use Alternative (1)fentanyl transdermal, tramadol.
    Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

  • fentanyl transmucosal

    Serious – Use Alternative (1)fentanyl transmucosal, tramadol.
    Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

  • fexinidazole

    Serious – Use Alternative (1)fexinidazole will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

  • flibanserin

    Monitor Closely (1)tramadol and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

  • fluoxetine

    Monitor Closely (1)fluoxetine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • fluphenazine

    Monitor Closely (1)tramadol and fluphenazine both increase sedation. Use Caution/Monitor.

  • flurazepam

    Monitor Closely (1)flurazepam and tramadol both increase sedation. Use Caution/Monitor.

  • fluvoxamine

    Monitor Closely (1)fluvoxamine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • formoterol

    Monitor Closely (1)tramadol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • fosphenytoin

    Monitor Closely (1)fosphenytoin will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • frovatriptan

    Monitor Closely (1)frovatriptan and tramadol both increase serotonin levels. Use Caution/Monitor.

  • gabapentin

    Monitor Closely (1)gabapentin, tramadol.
    Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

  • gabapentin enacarbil

    Monitor Closely (1)gabapentin enacarbil, tramadol.
    Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

  • givosiran

    Serious – Use Alternative (1)givosiran will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

  • haloperidol

    Monitor Closely (1)tramadol and haloperidol both increase sedation. Use Caution/Monitor.

  • hydrocodone

    Serious – Use Alternative (2)hydrocodone, tramadol.
    Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

    tramadol, hydrocodone. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • hydromorphone

    Monitor Closely (1)hydromorphone and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, hydromorphone. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • hydroxyzine

    Monitor Closely (1)hydroxyzine and tramadol both increase sedation. Use Caution/Monitor.

  • idelalisib

    Serious – Use Alternative (1)idelalisib will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

  • iloperidone

    Monitor Closely (2)tramadol and iloperidone both increase sedation. Use Caution/Monitor.

    iloperidone increases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

  • imipramine

    Monitor Closely (2)imipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and imipramine both increase sedation. Use Caution/Monitor.

  • indinavir

    Monitor Closely (1)indinavir increases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

  • iobenguane I 131

    Serious – Use Alternative (1)tramadol will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

  • isocarboxazid

    Serious – Use Alternative (2)isocarboxazid and tramadol both increase serotonin levels. Avoid or Use Alternate Drug.

    isocarboxazid increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

  • isoniazid

    Monitor Closely (1)isoniazid and tramadol both increase serotonin levels. Use Caution/Monitor.

  • isoproterenol

    Monitor Closely (1)tramadol increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • istradefylline

    Monitor Closely (1)istradefylline will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

  • itraconazole

    Monitor Closely (1)itraconazole will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • ivosidenib

    Serious – Use Alternative (1)ivosidenib will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

  • ketamine

    Monitor Closely (1)ketamine and tramadol both increase sedation. Use Caution/Monitor.

  • ketoconazole

    Monitor Closely (1)ketoconazole will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May require decreased tramadol dose or adjustment of dosing interval; increased risk for serious adverse events including seizures and serotonin syndrome

  • ketotifen, ophthalmic

    Monitor Closely (1)tramadol and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

  • L-tryptophan

    Monitor Closely (1)L-tryptophan and tramadol both increase serotonin levels. Use Caution/Monitor.

  • lasmiditan

    Monitor Closely (1)lasmiditan, tramadol.
    Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

  • lemborexant

    Monitor Closely (1)lemborexant, tramadol.
    Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

  • levalbuterol

    Monitor Closely (1)tramadol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • levomilnacipran

    Monitor Closely (1)levomilnacipran and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • levorphanol

    Monitor Closely (1)levorphanol and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, levorphanol. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • lidocaine

    Minor (1)lidocaine increases toxicity of tramadol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

  • linezolid

    Serious – Use Alternative (2)linezolid and tramadol both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

    linezolid increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

  • lisdexamfetamine

    Monitor Closely (2)tramadol, lisdexamfetamine.
    Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

    tramadol increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • lithium

    Monitor Closely (1)lithium and tramadol both increase serotonin levels. Use Caution/Monitor.

  • lofepramine

    Monitor Closely (2)lofepramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and lofepramine both increase sedation. Use Caution/Monitor.

  • lofexidine

    Monitor Closely (1)tramadol and lofexidine both increase sedation. Use Caution/Monitor.

  • lonafarnib

    Serious – Use Alternative (1)lonafarnib will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

  • lopinavir

    Monitor Closely (1)lopinavir will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • loprazolam

    Monitor Closely (1)loprazolam and tramadol both increase sedation. Use Caution/Monitor.

  • lorazepam

    Monitor Closely (1)lorazepam and tramadol both increase sedation. Use Caution/Monitor.

  • lorcaserin

    Monitor Closely (1)lorcaserin will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious – Use Alternative (1)tramadol and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

  • lorlatinib

    Monitor Closely (1)lorlatinib will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • lormetazepam

    Monitor Closely (1)lormetazepam and tramadol both increase sedation. Use Caution/Monitor.

  • loxapine

    Monitor Closely (1)tramadol and loxapine both increase sedation. Use Caution/Monitor.

  • loxapine inhaled

    Monitor Closely (1)tramadol and loxapine inhaled both increase sedation. Use Caution/Monitor.

  • lsd

    Monitor Closely (1)lsd and tramadol both increase serotonin levels. Use Caution/Monitor.

  • lumefantrine

    Monitor Closely (1)lumefantrine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

  • lurasidone

    Monitor Closely (1)lurasidone, tramadol.
    Either increases toxicity of the other by Other (see comment). Use Caution/Monitor.
    Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

  • maprotiline

    Monitor Closely (2)maprotiline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and maprotiline both increase sedation. Use Caution/Monitor.

  • maraviroc

    Minor (1)maraviroc will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

  • marijuana

    Monitor Closely (1)tramadol and marijuana both increase sedation. Use Caution/Monitor.Minor (1)marijuana will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

  • melatonin

    Monitor Closely (1)tramadol and melatonin both increase sedation. Use Caution/Monitor.

  • meperidine

    Monitor Closely (2)meperidine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    meperidine and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, meperidine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • meprobamate

    Monitor Closely (1)tramadol and meprobamate both increase sedation. Use Caution/Monitor.

  • metaproterenol

    Monitor Closely (1)tramadol increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • metaxalone

    Monitor Closely (1)metaxalone and tramadol both increase sedation. Use Caution/Monitor.

  • methadone

    Monitor Closely (1)methadone and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, methadone. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • methamphetamine

    Monitor Closely (1)tramadol increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • methocarbamol

    Monitor Closely (1)methocarbamol and tramadol both increase sedation. Use Caution/Monitor.

  • methylene blue

    Serious – Use Alternative (1)methylene blue and tramadol both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

  • methylenedioxymethamphetamine

    Monitor Closely (1)tramadol increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • metoclopramide intranasal

    Serious – Use Alternative (1)tramadol, metoclopramide intranasal.
    Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug.
    Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

  • midazolam

    Monitor Closely (1)midazolam and tramadol both increase sedation. Use Caution/Monitor.

  • midazolam intranasal

    Monitor Closely (1)midazolam intranasal, tramadol.
    Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

  • midodrine

    Monitor Closely (1)tramadol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • mifepristone

    Monitor Closely (1)mifepristone will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • milnacipran

    Monitor Closely (1)milnacipran and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • mirabegron

    Monitor Closely (1)mirabegron will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

  • mirtazapine

    Monitor Closely (2)tramadol and mirtazapine both increase sedation. Use Caution/Monitor.

    mirtazapine and tramadol both increase serotonin levels. Use Caution/Monitor.

  • mitotane

    Monitor Closely (1)mitotane decreases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

  • modafinil

    Monitor Closely (1)tramadol increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • morphine

    Monitor Closely (2)morphine and tramadol both increase sedation. Use Caution/Monitor.

    morphine and tramadol both increase serotonin levels. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, morphine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • motherwort

    Monitor Closely (1)tramadol and motherwort both increase sedation. Use Caution/Monitor.

  • moxonidine

    Monitor Closely (1)tramadol and moxonidine both increase sedation. Use Caution/Monitor.

  • nabilone

    Monitor Closely (1)tramadol and nabilone both increase sedation. Use Caution/Monitor.

  • nafcillin

    Monitor Closely (1)nafcillin will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • nalbuphine

    Monitor Closely (1)nalbuphine and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (2)tramadol, nalbuphine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

    nalbuphine, tramadol. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

  • naratriptan

    Monitor Closely (1)naratriptan and tramadol both increase serotonin levels. Use Caution/Monitor.

  • nefazodone

    Monitor Closely (2)nefazodone will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

    nefazodone and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • nelfinavir

    Monitor Closely (1)nelfinavir increases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

  • nevirapine

    Monitor Closely (1)nevirapine will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • nilotinib

    Minor (1)nilotinib will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

  • norepinephrine

    Monitor Closely (1)tramadol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • nortriptyline

    Monitor Closely (2)nortriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and nortriptyline both increase sedation. Use Caution/Monitor.

  • olanzapine

    Monitor Closely (1)tramadol and olanzapine both increase sedation. Use Caution/Monitor.

  • oliceridine

    Monitor Closely (2)oliceridine, tramadol.
    Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

    tramadol, oliceridine.
    Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.

  • opium tincture

    Monitor Closely (1)opium tincture and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, opium tincture. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • orphenadrine

    Monitor Closely (1)orphenadrine and tramadol both increase sedation. Use Caution/Monitor.

  • oxazepam

    Monitor Closely (1)oxazepam and tramadol both increase sedation. Use Caution/Monitor.

  • oxcarbazepine

    Monitor Closely (1)oxcarbazepine will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • oxycodone

    Monitor Closely (1)oxycodone and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, oxycodone. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • oxymorphone

    Monitor Closely (1)oxymorphone and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, oxymorphone. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • ozanimod

    Serious – Use Alternative (1)ozanimod increases toxicity of tramadol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

  • paliperidone

    Monitor Closely (1)tramadol and paliperidone both increase sedation. Use Caution/Monitor.

  • papaveretum

    Monitor Closely (1)papaveretum and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, papaveretum. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • papaverine

    Monitor Closely (1)tramadol and papaverine both increase sedation. Use Caution/Monitor.

  • parecoxib

    Minor (1)parecoxib will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

  • paroxetine

    Monitor Closely (2)paroxetine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    paroxetine decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.Minor (1)paroxetine decreases effects of tramadol by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of tramadol to active metabolite.

  • peginterferon alfa 2b

    Monitor Closely (1)peginterferon alfa 2b, tramadol. Other (see comment). Use Caution/Monitor.
    Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

  • pegvisomant

    Monitor Closely (1)tramadol decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

  • pentazocine

    Monitor Closely (2)pentazocine and tramadol both increase sedation. Use Caution/Monitor.

    pentazocine and tramadol both increase serotonin levels. Use Caution/Monitor.Serious – Use Alternative (2)tramadol, pentazocine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

    pentazocine, tramadol. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

  • pentobarbital

    Monitor Closely (2)pentobarbital will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

    pentobarbital and tramadol both increase sedation. Use Caution/Monitor.

  • perampanel

    Monitor Closely (1)perampanel and tramadol both increase sedation. Use Caution/Monitor.

  • perphenazine

    Monitor Closely (1)tramadol and perphenazine both increase sedation. Use Caution/Monitor.

  • phendimetrazine

    Monitor Closely (1)tramadol increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • phenelzine

    Serious – Use Alternative (2)phenelzine and tramadol both increase serotonin levels. Avoid or Use Alternate Drug.

    phenelzine increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

  • phenobarbital

    Monitor Closely (2)phenobarbital will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

    phenobarbital and tramadol both increase sedation. Use Caution/Monitor.

  • phentermine

    Monitor Closely (1)tramadol increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • phenylephrine

    Monitor Closely (1)tramadol increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • phenytoin

    Monitor Closely (1)phenytoin will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • pholcodine

    Monitor Closely (1)tramadol and pholcodine both increase sedation. Use Caution/Monitor.

  • pimozide

    Monitor Closely (1)tramadol and pimozide both increase sedation. Use Caution/Monitor.

  • pirbuterol

    Monitor Closely (1)tramadol increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • posaconazole

    Serious – Use Alternative (1)posaconazole will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • pregabalin

    Monitor Closely (1)pregabalin, tramadol.
    Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

  • primidone

    Monitor Closely (2)primidone will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

    primidone and tramadol both increase sedation. Use Caution/Monitor.

  • procarbazine

    Contraindicated (1)procarbazine and tramadol both increase serotonin levels. Contraindicated.Serious – Use Alternative (1)procarbazine increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

  • prochlorperazine

    Monitor Closely (1)tramadol and prochlorperazine both increase sedation. Use Caution/Monitor.

  • promethazine

    Monitor Closely (1)promethazine and tramadol both increase sedation. Use Caution/Monitor.

  • propafenone

    Monitor Closely (2)propafenone decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

    propafenone decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

  • propofol

    Monitor Closely (1)propofol and tramadol both increase sedation. Use Caution/Monitor.

  • propylhexedrine

    Monitor Closely (1)tramadol increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • protriptyline

    Monitor Closely (2)protriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and protriptyline both increase sedation. Use Caution/Monitor.

  • quazepam

    Monitor Closely (1)quazepam and tramadol both increase sedation. Use Caution/Monitor.

  • quetiapine

    Monitor Closely (1)tramadol and quetiapine both increase sedation. Use Caution/Monitor.

  • quinacrine

    Monitor Closely (2)quinacrine decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

    quinacrine decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

  • quinidine

    Monitor Closely (2)quinidine decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

    quinidine decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

  • ramelteon

    Monitor Closely (1)tramadol and ramelteon both increase sedation. Use Caution/Monitor.

  • ranolazine

    Minor (1)ranolazine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

  • rasagiline

    Contraindicated (1)rasagiline and tramadol both increase serotonin levels. Contraindicated.

  • remifentanil

    Monitor Closely (1)tramadol, remifentanil.
    Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

  • remimazolam

    Monitor Closely (1)remimazolam, tramadol.
    Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

  • ribociclib

    Serious – Use Alternative (1)ribociclib will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • rifabutin

    Monitor Closely (1)rifabutin will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • rifampin

    Monitor Closely (1)rifampin will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • rifapentine

    Monitor Closely (1)rifapentine will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decreased AUC of tramadol and the active metabolite (O-desmethyltramadol) when coadministered with strong CYP3A4 and CYP2B6 inducers

  • risperidone

    Monitor Closely (1)tramadol and risperidone both increase sedation. Use Caution/Monitor.

  • ritonavir

    Monitor Closely (1)ritonavir will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May require decreased tramadol dose or adjustment of dosing interval; increased risk for serious adverse events including seizures and serotonin syndrome

  • rizatriptan

    Monitor Closely (1)rizatriptan and tramadol both increase serotonin levels. Use Caution/Monitor.

  • rolapitant

    Monitor Closely (1)rolapitant will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

  • rucaparib

    Monitor Closely (1)rucaparib will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

  • safinamide

    Contraindicated (1)tramadol, safinamide.
    Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

  • sage

    Minor (1)tramadol and sage both increase sedation. Minor/Significance Unknown.

  • salmeterol

    Monitor Closely (1)tramadol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • SAMe

    Monitor Closely (1)SAMe and tramadol both increase serotonin levels. Use Caution/Monitor.

  • saquinavir

    Monitor Closely (1)saquinavir will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • scullcap

    Monitor Closely (1)tramadol and scullcap both increase sedation. Use Caution/Monitor.

  • secobarbital

    Monitor Closely (1)secobarbital and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)secobarbital will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. May also enhance CNS depressant effect of tramadol

  • selegiline

    Contraindicated (1)selegiline and tramadol both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of analgesic.

  • selegiline transdermal

    Monitor Closely (1)selegiline transdermal and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.Serious – Use Alternative (1)selegiline transdermal increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

  • selinexor

    Serious – Use Alternative (1)selinexor, tramadol. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

  • sertraline

    Monitor Closely (3)sertraline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    sertraline decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

    sertraline decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

  • sevoflurane

    Monitor Closely (1)sevoflurane and tramadol both increase sedation. Use Caution/Monitor.

  • shepherd’s purse

    Monitor Closely (1)tramadol and shepherd’s purse both increase sedation. Use Caution/Monitor.

  • sodium oxybate

    Serious – Use Alternative (1)tramadol, sodium oxybate.
    Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

  • St John’s Wort

    Monitor Closely (1)St John’s Wort and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • stiripentol

    Monitor Closely (2)stiripentol, tramadol.
    Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

    stiripentol, tramadol. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

  • sufentanil

    Monitor Closely (1)sufentanil and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, sufentanil. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • sufentanil SL

    Serious – Use Alternative (1)sufentanil SL, tramadol.
    Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

  • sumatriptan

    Monitor Closely (1)sumatriptan and tramadol both increase serotonin levels. Use Caution/Monitor.

  • sumatriptan intranasal

    Monitor Closely (1)sumatriptan intranasal and tramadol both increase serotonin levels. Use Caution/Monitor.

  • suvorexant

    Monitor Closely (1)suvorexant and tramadol both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

  • tapentadol

    Monitor Closely (2)tramadol and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tapentadol and tramadol both increase sedation. Use Caution/Monitor.Serious – Use Alternative (1)tramadol, tapentadol. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

  • tazemetostat

    Monitor Closely (1)tazemetostat will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • tecovirimat

    Monitor Closely (1)tecovirimat will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

  • tedizolid

    Serious – Use Alternative (1)tedizolid, tramadol.
    Either increases levels of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

  • temazepam

    Monitor Closely (1)temazepam and tramadol both increase sedation. Use Caution/Monitor.

  • terbinafine

    Monitor Closely (1)terbinafine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

  • terbutaline

    Monitor Closely (1)tramadol increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • thioridazine

    Monitor Closely (3)thioridazine decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

    tramadol and thioridazine both increase sedation. Use Caution/Monitor.

    thioridazine decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

  • thiothixene

    Monitor Closely (1)tramadol and thiothixene both increase sedation. Use Caution/Monitor.

  • tipranavir

    Monitor Closely (1)tipranavir will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)tipranavir will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

  • topiramate

    Monitor Closely (1)tramadol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

  • tranylcypromine

    Serious – Use Alternative (2)tranylcypromine and tramadol both increase serotonin levels. Avoid or Use Alternate Drug.

    tranylcypromine increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

  • trazodone

    Monitor Closely (2)trazodone and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and trazodone both increase sedation. Use Caution/Monitor.

  • triazolam

    Monitor Closely (1)triazolam and tramadol both increase sedation. Use Caution/Monitor.

  • triclofos

    Monitor Closely (1)triclofos and tramadol both increase sedation. Use Caution/Monitor.

  • trifluoperazine

    Monitor Closely (1)tramadol and trifluoperazine both increase sedation. Use Caution/Monitor.

  • trimipramine

    Monitor Closely (2)trimipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

    tramadol and trimipramine both increase sedation. Use Caution/Monitor.

  • triprolidine

    Monitor Closely (1)triprolidine and tramadol both increase sedation. Use Caution/Monitor.

  • tucatinib

    Serious – Use Alternative (1)tucatinib will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

  • valerian

    Serious – Use Alternative (1)valerian and tramadol both increase sedation. Avoid or Use Alternate Drug.

  • venlafaxine

    Monitor Closely (1)venlafaxine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

  • vilazodone

    Serious – Use Alternative (1)tramadol, vilazodone.
    Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated.

  • voriconazole

    Monitor Closely (1)voriconazole will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • vortioxetine

    Serious – Use Alternative (1)tramadol, vortioxetine.
    Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

  • voxelotor

    Serious – Use Alternative (1)voxelotor will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

  • xylometazoline

    Monitor Closely (1)tramadol increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • yohimbine

    Monitor Closely (1)tramadol increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • ziconotide

    Monitor Closely (1)tramadol and ziconotide both increase sedation. Use Caution/Monitor.Minor (1)ziconotide, tramadol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

  • ziprasidone

    Monitor Closely (1)tramadol and ziprasidone both increase sedation. Use Caution/Monitor.

  • zolmitriptan

    Monitor Closely (1)zolmitriptan and tramadol both increase serotonin levels. Use Caution/Monitor.

  • zotepine

    Monitor Closely (1)tramadol and zotepine both increase sedation. Use Caution/Monitor.

  • Similarities, Differences, Side Effects & More

    Two commonly prescribed prescription painkillers are tramadol and Lortab. How do tramadol and Lortab compare to one another? There are similarities and differences between these two drugs.

    Article at a Glance:

    • Tramadol and Lortab both contain opioids for the active ingredient.
    • Both medications are used to treat short- and long-term pain.
    • They have similar side effects including drowsiness, dizziness and a high potential for abuse.
    • Tramadol is generally safer for older adults or people with a low opioid tolerance.
    • Tramadol carries a risk of seizures while Lortab does not.
    • The acetaminophen in Lortab can increase the risk of liver damage if used in high doses or combined with other medications that contain acetaminophen.

    Comparing Tramadol and Lortab

    Tramadol and Lortab are both fairly well-known pain medications. Tramadol is usually used for mild to moderate pain, while Lortab is used for moderate to severe pain since it is more potent.

    Other names for Lortab include Vicodin and Norco. It contains two different active ingredients (hydrocodone and acetaminophen), where tramadol only contains one. The inclusion of acetaminophen means that Lortab has a higher risk of liver damage than Tramadol.

    If these medications both treat pain, why would one be used over the other?

    Similarities Between Tramadol and Lortab

    Both medications can be prescribed to treat pain and conditions where pain is a symptom. Lortab contains the active ingredient hydrocodone, which is an opioid medication. Tramadol is also an opioid.

    Since both are opioids, they have similar side effects including drowsiness, dizziness, nausea, vomiting, constipation and slowed breathing.

    Like other opioids, there is a potential for fatal overdose if you take too much of these medications. Symptoms of an overdose include very slow breathing, bluish skin, and unconsciousness. An opioid overdose is a medical emergency.

    Both medications have a high potential for addiction and abuse and both are controlled substances.

    Differences Between Tramadol and Lortab

    Tramadol

    • Tramadol has similar effects as an antidepressant but is not prescribed to treat depression or other mental health conditions. These effects may contribute to the potential for abuse.
    • Since tramadol is less potent, it is usually safer for people at risk of opioid side effects, like older adults.
    • Tramadol can increase the risk of seizures.

    Lortab

    • Lortab can help with a cough and with reducing fever. The hydrocodone in Lortab helps coughs, while the acetaminophen is good for reducing fever.
    • Lortab contains acetaminophen (generic Tylenol), so taking too much can cause liver damage.
    • Lortab is more potent than Tramadol and should be taken in smaller doses to reduce the risk of overdose.

    Tramadol and Lortab also have different dosages and potencies.

    Tramadol 50 mg vs Lortab 10 mg

    The standard dosage of Tramadol is 25-100 mg every 4-6 hours as needed. The effective dose will vary from person to person based on different factors. The standard dosage of Lortab is 5-325 mg is 1-2 tabs every 4-6 hours as needed.

    Tramadol 50 mg and Lortab 10 mg are moderate dosages, but the Lortab dose is more potent than tramadol.

    Side Effects

    Tramadol and Lortab share many potential side effects, including dizziness, sore throat, itching, drowsiness, headache, constipation, nausea and vomiting, and weakness. Potentially serious side effects of both medications include confusion, low blood pressure, respiratory depression and gastric obstruction.

    Since tramadol works slightly differently than Lortab, it has unique side effects, including seizures, serotonin syndrome and mood changes.

    Another potential side effect is the risk of abuse. According to the DEA, hydrocodone is currently one of the most abused opioids in the U.S., but this could be because it is prescribed more often than tramadol. Both have a high potential for abuse.

    FAQs

    • Can You Take Tramadol and Lortab Together?

      Tramadol and Lortab should not be used together. Both are prescribed for short-term pain, but taking them together will not give an extra benefit. Instead, combining these medications can increase the risk of fatal overdose.

    • What is Tramadol?

      Tramadol is a prescription drug sold under the brand name Ultram and it is commonly used for people who may be more sensitive to opioids, like older adults and patients at risk for drug abuse.

      Tramadol is an opioid analgesic, which means it impacts the central nervous system (CNS) and relieves pain by changing how your brain and body perceive it. When you take tramadol, as with other opioids, it binds to opioid receptors, but it also increases certain neurotransmitters, including norepinephrine and serotonin. Tramadol is also available in combination with acetaminophen, sold under the brand name Ultracet.

      Because of the opioid effects of tramadol, it is a controlled substance with a high potential for abuse.

    • What is Lortab?

      Lortab contains the active medications hydrocodone and acetaminophen. Hydrocodone is an opioid with a high potential for addiction and abuse. It is also very effective at treating pain. Acetaminophen is combined with hydrocodone to reduce the amount of opioids needed to treat pain symptoms.

      Hydrocodone works by binding to opioid receptors and reducing the sensation of pain transmitted through the nervous system. Acetaminophen works by activating nerve cells that suppress feelings of pain.

    Tramadol Drug Properties

    Brand names Ultram, ConZip, Qdolo
    Type of pain it can treat Post-operative pain, non-cancer long-term pain
    Short-acting or long-acting Short-acting
    Drug type Opioid
    Drug schedule Schedule IV
    Side effects CNS depression, constipation, dizziness, sedation, headache, anxiety, euphoria, depression, respiratory depression, seizures, withdrawal symptoms
    How long it takes to start working 60 minutes
    How long it takes to have its peak effect 2-3 hours
    Duration of effect 6-8 hours

    Lortab Drug Properties

    Brand names Lortab, Vicodin HP, Xodol
    Type of pain it can treat Long-term pain (non-cancer and non-palliative), post-operative pain
    Short-acting or long-acting Short-acting
    Drug type Opioid and nonopioid analgesic
    Drug schedule Schedule III
    Side effects Constipation, liver toxicity, CNS depression, low blood pressure, respiratory depression, drowsiness, nausea and vomiting, dizziness, slow heart rate, withdrawal symptoms
    How long it takes to start working 30-60 minutes
    How long it takes to have its peak effect 60 minutes
    Duration of effect 4-6 hours

    Abuse Potential

    Research has found that many people are introduced to opioids through a legitimate prescription, but go on to develop dependence or addiction. If you or someone you know is struggling with opioids, The Recovery Village can help. Contact us today to learn more about treatment options for opioid addiction.

    Learn more about tramadol abuse → or Learn more about Lortab abuse →

    Safety and Efficacy of Tramadol in COVID-19 Egyptian Patients – Full Text View

    Background and Rationale:

    T cells play a critical role in antiviral immunity, their level was dramatically reduced in COVID-19 patients. There is a negative correlation between T cell numbers and cytokines serum level in COVID-19 patients. In those patients, there is up-regulation of inflammatory cytokines including interleukin (IL)-1, IL-6, tumor necrosis factor (TNF)-α, and interferon γ. This makes the use of tramadol reasonable in such patients because it has anti-inflammatory effect decreasing plasma level of TNF-α after treatment with a dose of 100 mg every 12 hours for 10 days, which may result in a subsequent increase in T cell numbers.

    Besides, COVID-19 patients with acute respiratory failure present with severe hypercoagulability due to hyperfibrinogenemia resulting in increased fibrin formation and polymerization that may predispose to thrombosis. It has been reported that tramadol has a hypocoagulable effect in the blood of women with gynecologic malignancies. Consequently, tramadol may be useful for patients who have a tendency toward a hypercoagulable status and thromboembolic complications. Moreover, tramadol could affect hemostatic parameters in favor of bleeding tendency in rats.

    On the other hand, the severity and mortality risk of COVID-19 have been associated with the age. This age-related mortality is attributed to the shortage of antioxidant mechanisms and increased oxidative damage. Tramadol increased the antioxidant enzymes superoxide dismutase and glutathione peroxidase while diminished the oxidative stress marker malondialdehyde in testicular ischemia-reperfusion injury in rats. Owing to its antioxidant properties, tramadol could reduce complications in COVID-19 patients.

    Moreover, tramadol was reported to significantly lower lactate dehydrogenase (LDH) level and to provide a cardio-protective effect. This property of tramadol seems beneficial since it was found that, about 60% of COVID-19 patients are presented with elevated LDH levels. Tramadol has also antitussive property. Tramadol is a unique analgesic offering moderate, dose-related pain relief through its action at multiple sites. In contrast to pure opioid agonists, it has a low risk of respiratory depression, tolerance, and dependence. Previous studies confirmed that tramadol dependence may occur when it is used daily for more than a few weeks/months.

    More interestingly, patients infected with COVID-19 may experience intense emotional and behavioral reactions, such as fear, loneliness, anxiety, insomnia, or anger. These conditions can be especially prevalent in quarantined patients. Tramadol is a centrally acting analgesic drug with a dual mechanism of action: binding to μ-opioid receptors and the inhibition of serotonin and norepinephrine reuptake. Through its ability to inhibit serotonin and norepinephrine reuptake, tramadol may exhibit antidepressant activity. In this context, the analgesic and antidepressant effects of tramadol may favor its use for COVID-19 patients. Tramadol also was found to have dose- and time-dependent bactericidal activity against Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa pathogens in vitro.

    Tramadol for pain relief (Mabron, Tilodol, Zamadol) | Medicine

    About tramadol

    Type of medicine Strong opioid painkiller
    Used for Pain relief in adults and in children over 12 years of age
    Also called Invodol®; Mabron®; Maneo®; Marol®; Maxitram®; Tilodol®; Tradorec®; Tramquel®; Tramulief®; Zamadol®; Zeridame®; Zydol®;
    In combination with paracetamol: Tramacet®; Trapadex®
    In combination with dexketoprofen: Skudexa®
    Available as Capsule, soluble tablet, orodispersible tablet (dissolves in the mouth), modified-release tablets and capsules, oral drops and injection

    Strong opioids (sometimes called opiates) are medicines used to treat severe pain. Tramadol is a type of strong opioid. It works on your nervous system and brain to reduce the amount of pain you feel.

    There are many different forms, strengths and brands of tramadol. Some forms and brands of tramadol start working quickly to ease pain. Others release the tramadol they contain more slowly over several hours to provide a constant and more even pain control – these are called ‘modified-release’ and often have ‘XL’, ‘SR’ or ’24hr’ after their brand name.

    Before taking tramadol

    Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking tramadol, it is important that your doctor knows:

    • If you are pregnant, trying for a baby or breastfeeding.
    • If you have liver or kidney problems.
    • If you have prostate problems or any difficulties passing urine.
    • If you have any breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD), or a sleep-related breathing problem.
    • If you have been told you have low blood pressure (hypotension).
    • If you have any problems with your thyroid or adrenal glands.
    • If you have epilepsy.
    • If you have a problem with your bile duct.
    • If you have been constipated for more than a week or have an inflammatory bowel problem.
    • If you have a condition causing muscle weakness, called myasthenia gravis.
    • If you have recently had a severe head injury.
    • If you have ever been dependent on drugs or alcohol.
    • If you have ever had an allergic reaction to a medicine.
    • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

    How to take tramadol

    • Before you start this treatment, read the manufacturer’s printed information leaflet from inside your pack. The manufacturer’s leaflet will give you more information about the specific brand of tramadol you have been prescribed, and a full list of the side-effects which you may experience from taking it.
    • Take tramadol exactly as your doctor tells you to. Depending on the reason you are taking it, your doctor may advise that you take regular doses or only when you need it for pain relief. Make sure you know which is right for you.
    • If you have been prescribed quick-acting tablets or capsules, you will be asked to take a dose every 4-6 hours. If you have been given modified-release tablets or capsules, you will be asked to take either two doses a day (taken 12 hours apart) or just one dose daily (at the same time of day each day). Your dose will be printed on the label of the pack to remind you, but if you are still unsure about what to do, ask your pharmacist for further advice. Do not take more than a total of 400 mg of tramadol in any 24-hour period.
    • If you have been given modified-release tablets or capsules, it is important that you do not break the tablets or chew the contents of the capsules; otherwise they may release the medicine too quickly and cause side-effects. Swallow the tablets/capsules whole with a drink of water, unless the label says you may do otherwise.
    • You can take tramadol before or after food.
    • If you forget to take a dose, check the manufactuer’s information leaflet for advice about what to do. Depending upon when your next dose is due, you will either be recommended to take a dose when you remember or wait for your next dose. Never take two doses together to make up for a missed dose.

    Getting the most from your treatment

    • Ask your doctor for advice before drinking alcohol while you are on this medicine. Your doctor may recommend you do not drink alcohol while you are on tramadol because it increases the possibility of side-effects such as feeling dizzy and sleepy.
    • If you are a driver, please be aware that tramadol is likely to affect your reactions and ability to drive. It is an offence to drive while your reactions are impaired. Even if your driving ability is not impaired, should you drive, you are advised to carry with you some evidence that the medicine has been prescribed for you – a repeat prescription form or a patient information leaflet from the pack is generally considered suitable.
    • As there are several different brands and strengths of tramadol, each time you collect a prescription, check to make sure it contains what you are expecting. Ask your pharmacist to check for you if you are unsure about anything.
    • If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking tramadol as a painkiller.
    • If you buy any medicines, check with a pharmacist that they are suitable for you to take with tramadol. Many other medicines have similar side-effects to tramadol, and taking them together will increase the risk of unwanted effects.
    • If you are planning a trip abroad, you are advised to carry a letter with you from your doctor to explain that you have been prescribed tramadol. This is because tramadol is classed as a ‘controlled drug’ and is subject to certain restrictions.
    • Do not take tramadol for longer than you have been advised by your doctor. This is because repeatedly using tramadol may lead to your body becoming dependent on it. When you then stop taking it, it will cause withdrawal symptoms such as restlessness and irritability. If you are concerned about this, discuss it with your doctor or pharmacist.

    Can tramadol cause side-effects?

    Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with tramadol. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

    Common tramadol side-effects – these affect around 1 in 10 people who take this medicine
    What can I do if I experience this?
    Feeling dizzy, tired or sleepy If this happens, do not drive and do not use tools or machines. Do not drink alcohol
    Feeling sick (nausea) or being sick (vomiting) Stick to simple meals – avoid rich or spicy foods
    Constipation Eat a well-balanced diet and drink plenty of water each day. If this continues to be a problem, speak with your doctor
    Dry mouth Try chewing sugar-free gum or sucking sugar-free sweets
    Less common side-effects include: headache, diarrhoea, itchy rash, and sweating If any of these become troublesome, speak with your doctor

    Important: people taking opioid medicines, and their family and friends, should be aware of the risk of accidental overdose and know when to seek medical help. The risk is higher if you also take other medicines that make you feel drowsy. Signs you have taken too much medicine include:

    • Feeling very sleepy or dizzy.
    • Feeling sick (nausea) or being sick (vomiting).
    • Breathing difficulties.
    • Loss of consciousness.

    If you have taken more tramadol than you should or someone else accidentally swallows your medication, call for an ambulance and tell them the name of your medicine.

    If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist. 

    How to store tramadol

    • Keep all medicines out of the reach and sight of children.
    • Store in a cool, dry place, away from direct heat and light. 

    Important information about all medicines

    Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

    This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

    Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

    If you have any questions about this medicine ask your pharmacist.

    Differences, similarities, and which one is better

    Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

    Tramadol and hydrocodone are two medications used to treat pain that is not easily relieved with a non-opioid analgesic. Both medications can treat moderate to severe pain after surgery or in chronic conditions such as cancer. However, for many cases of pain, non-opioid therapy is usually tried first.

    Both tramadol and hydrocodone work by binding to mu opioid receptors to change how a person responds to pain. As prescription opioids, they are more potent than your average over-the-counter pain reliever. Therefore, these drugs require a visit with a doctor to assess your pain.

    What are the main differences between Tramadol and Hydrocodone?

    Tramadol is the generic name for Ultram, Ultram ER, and ConZip. It is a Schedule IV narcotic according to the DEA which means it has some potential for abuse. While it binds to mu opioid receptors, it can also increase the activity of other brain neurotransmitters such as norepinephrine and serotonin.

    Hydrocodone is the generic name for Zohydro ER and Hysingla ER. Hydrocodone is also taken as a combination tablet with acetaminophen under the brand names Vicodin or Lortab. Unlike tramadol, hydrocodone is a Schedule II DEA controlled medication which has a higher risk of abuse.

    Main differences between Tramadol and Hydrocodone
    Drug class Opioid Opioid
    Brand/generic status Generic version available Generic version available
    What is the generic name?
    What is the brand name?
    Generic: Tramadol
    Brand: Ultram, Ultram ER
    Generic: Hydrocodone
    Brand: Zohydro ER, Hysingla ER, Vicodin (combined with acetaminophen), Lortab (combined with acetaminophen), Norco (combined with acetaminophen)
    What form(s) does the drug come in? Oral tablet
    Oral tablet, extended-release
    Oral capsule
    Oral suspension
    Oral tablet
    Oral tablet, extended-release
    Oral capsule
    Oral solution
    What is the standard dosage? Ultram: 50 to 100 mg every 4 to 6 hours as needed
    Ultram ER: 100 mg every 24 hours
    Zohydro ER:10 mg every 12 hours
    Hysingla ER: 20 mg every 24 hours
    Vicodin, Lortab, Norco (combination with acetaminophen): 5 to 10 mg every 4 to 6 hours as needed
    How long is the typical treatment? Daily as needed.
    Treatment duration depends on your doctor’s instruction.
    Daily as needed.
    Treatment duration depends on your doctor’s instruction.
    Who typically uses the medication? Adults 18 years and older Adults 18 years and older

    Conditions treated by Tramadol and Hydrocodone

    Tramadol and hydrocodone are both indicated for pain management. They are usually prescribed if you have moderate to severe chronic pain, especially from conditions such as cancer. Both medications are also typically used for pain after injury and surgery.

    Moderate to severe pain Yes Yes
    Chronic pain Yes Yes
    Pain from injury or after surgery Yes Yes
    Cancer Pain Yes Yes

    Is Tramadol or Hydrocodone more effective?

    Tramadol and hydrocodone are both effective prescription opioids for pain. There are several studies comparing their effectiveness. Because hydrocodone is a Schedule II opiate, it may be considered more potent although it comes with a higher potential for abuse. Tramadol may have a lower abuse potential as well as milder side effects.

    In one multicenter study, tramadol with acetaminophen was compared with hydrocodone with acetaminophen in patients experiencing pain from an ankle sprain. Around 400 patients were split into two groups receiving one drug or the other. Results found that both medications provide comparable pain relief within four hours versus placebo.

    In another clinical trial, hydrocodone with acetaminophen was compared with tramadol in 68 patients. These patients had arrived at an emergency department for musculoskeletal pain in their joints, bones, or muscles. Results found that hydrocodone with acetaminophen provides more pain relief compared to tramadol based on pain scores with a visual analog scale (VAS).

    In a double-blind trial, hydrocodone with acetaminophen was compared to tramadol in 118 patients with chronic pain from cancer. Tramadol showed pain relief in 62% of patients compared to 56.5% of patients with hydrocodone. However, pain relief was similar in both groups. Tramadol was also found to produce milder side effects versus hydrocodone.

    Whether you are prescribed tramadol or hydrocodone is highly dependent on the level of your pain. When assessing your pain, your doctor will look at your complete medical history, any history of substance abuse, and any medications that could cause drug interactions. Therefore, pain medications are highly individualized and require a doctor’s consultation to determine which will be more effective for you.

    Coverage and cost comparison of Tramadol vs. Hydrocodone

    Tramadol is available as a generic drug. It is typically covered by Medicare and most insurance plans. The average cost of a supply of sixty 50 mg tramadol tablets is around $40. You save more with a SingleCare coupon for generic tramadol at your local pharmacy.

    Hydrocodone is a generic drug that is often covered by Medicare and most insurance plans. The cost of hydrocodone varies between different insurance plans. Norco which contains hydrocodone and acetaminophen can run at an average cost of $317. With a SingleCare coupon, you can expect to save more on a prescription for hydrocodone with acetaminophen.

    Typically covered by insurance? Yes Yes
    Typically covered by Medicare? Yes Yes
    Standard dosage 50 mg tablets (supply of 60)
    Depends on your doctor’s prescription
    5-325 mg tablets (supply of 100)
    Depends on your doctor’s prescription
    Typical Medicare copay $40 $317
    SingleCare cost $15 $18

    Common side effects of Tramadol and Hydrocodone

    Tramadol and hydrocodone can cause similar side effects. Because they both affect the central nervous system (CNS), they can both cause dizziness, sleepiness, and fatigue. These medications can also cause gastrointestinal side effects such as constipation or stomach ache. Nausea, vomiting, dry mouth, and headache are other shared side effects.

    Tramadol can also cause diarrhea, indigestion, and sweating in some people. On the other hand, hydrocodone can also cause fluid buildup (edema) or muscle spasms in some people. Overall, common side effects can overlap between these two drugs since they are in the same class.

    Other rare but serious side effects of tramadol and hydrocodone can include anxiety, depression, or other psychiatric disturbances. Allergic reactions are also possible and can include rash, flushing, and chest pain.

    Side Effect Applicable? Frequency Applicable? Frequency
    Constipation Yes 24-46% Yes 11%
    Dizziness Yes 26-33% Yes 3%
    Nausea Yes 24-40% Yes 10%
    Headache Yes 18-32% Yes 4%
    Drowsiness Yes 16-25% Yes 5%
    Vomiting Yes 9-17% Yes 3%
    Itching (Pruritus) Yes 8-11% Yes 3%
    Weakness Yes 6-12% Yes 4%
    Sweating Yes 6-9% No
    Indigestion Yes 5-13% No
    Dry mouth Yes 5-10% Yes 3%
    Diarrhea Yes 5-10% No
    Edema No Yes 1%
    Respiratory infection No Yes 1%
    Muscle spasms No Yes 1%
    Back pain No Yes 1%

    *Consult a doctor or pharmacist for all possible side effects.

    Source: DailyMed (Tramadol HCl), DailyMed (Zohydro ER).

    Drug interactions of Tramadol vs. Hydrocodone

    Tramadol and hydrocodone have similar interactions with other drugs. Because they are metabolized in the liver, they tend to interact with other drugs that affect liver enzymes.

    Drugs that inhibit CYP3A4 and CYP2D6 liver enzymes include erythromycin, ketoconazole, and ritonavir which can increase the level of opioids in the body and increase the risk of side effects. Drugs that induce CYP3A4 liver enzymes include carbamazepine and phenytoin which can decrease the level of opioids in the body and decrease their effectiveness.

    Tramadol and hydrocodone can also interact with other drugs that have CNS side effects. These types of drugs include antidepressants, anticonvulsants, benzodiazepines, muscle relaxers, and many more. Taking opioids with antidepressants that increase serotonin can increase the risk of serotonin syndrome, a serious condition that requires emergency medical attention.

    According to the FDA drug label, tramadol can also interact with digoxin and warfarin. Reports have found rare instances of digoxin toxicity and altered warfarin effects. The FDA label for hydrocodone also mentions that strong laxatives may decrease the effects of hydrocodone in the body.

    It is not recommended to drink alcohol while using opioids. Alcohol may compound the side effects of opioids such as drowsiness and dizziness.

    Erythromycin
    Clarithromycin
    Telithromycin
    Rifampin
    Antibiotic Yes Yes
    Ketoconazole
    Itraconazole
    Antifungal agent Yes Yes
    Ritonavir
    Atazanavir
    Darunavir
    Indinavir
    Lopinavir
    Saquinavir
    Protease inhibitor Yes Yes
    Phenytoin
    Carbamazepine
    Anticonvulsant Yes Yes
    Escitalopram
    Fluoxetine
    Paroxetine
    Sertraline
    Citalopram
    Selective serotonin reuptake inhibitor (SSRI) antidepressant Yes Yes
    Venlafaxine
    Milnacipran
    Duloxetine
    Desvenlafaxine
    Serotonin-norepinephrine reuptake inhibitor (SSNRI) antidepressant Yes Yes
    Doxepin
    Amitriptyline
    Clomipramine
    Desipramine
    Imipramine
    Nortriptyline
    TCA antidepressant Yes Yes
    Naratriptan
    Rizatriptan
    Sumatriptan
    Zolmitriptan
    Triptan Yes Yes
    Alprazolam
    Clonazepam
    Diazepam
    Lorazepam
    Benzodiazepine Yes Yes
    Rasagiline
    Isocarboxazid
    Phenelzine
    Selegiline
    Tranylcypromine
    Monoamine oxidase inhibitor (MAOI) Yes Yes
    Cyclobenzaprine
    Metaxalone
    Muscle relaxant Yes Yes
    Lactulose Strong laxative No Yes
    Digoxin Cardiac glycoside Yes No
    Warfarin Anticoagulant Yes No

    *This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking.

    Warnings of Tramadol and Hydrocodone

     

    Tramadol and hydrocodone carry a warning for addiction and abuse if not used as prescribed. Addiction can lead to physical dependence which can result in withdrawal symptoms if the drug is stopped for any reason. Withdrawal symptoms can include anxiety, insomnia, and agitation.

    Taking more than the prescribed dose of opioids can increase the risk of overdose, coma, and death. Life-threatening side effects such as severe respiratory depression and stupor can occur with overdose. For this reason, opioids are not recommended in children due to the increased risk of breathing problems and death.

    It is not recommended to drink alcohol or take other CNS drugs with opioids. This is because they increase the risk of CNS effects like sedation, slow breathing, coma, and death. Although more data is needed, new research suggests that tramadol may have a higher risk of overall death compared to anti-inflammatory medications.

    Both tramadol and hydrocodone are in pregnancy category C. Therefore, they are not typically recommended for women who are pregnant or breastfeeding due to the risk of harm to the unborn baby. Seek medical advice if you are pregnant or planning pregnancy.

    Frequently asked questions about Tramadol vs. Hydrocodone

    What is tramadol?

    Tramadol is an opioid medication used to treat moderate to severe pain. It is a Schedule IV drug that requires a prescription and a pain assessment by a doctor. It is available in an immediate-release and extended-release form depending on pain severity.

    What is hydrocodone?

    Hydrocodone is an opioid medication that can treat moderate to severe pain. It is a Schedule II drug that may have a high potential for abuse and dependence. It is available in an extended-release form as well as a combination pill with acetaminophen.

    Are tramadol and hydrocodone the same?

    Although they are both opioids, tramadol and hydrocodone are not the same. They have similar uses depending on the pain you are experiencing. But they also come in different dosage forms and have some different side effects and drug interactions.

    Is tramadol or hydrocodone better?

    Studies show that tramadol and hydrocodone are both comparatively effective for pain. Some reports show that tramadol has milder side effects compared to hydrocodone. However, other studies show that hydrocodone is more potent and produces more pain relief in some people.

    Is tramadol stronger than codeine?

    Both tramadol and codeine can relieve pain and they are both considered relatively weak opioids. However, they may differ in their side effects and uses. Unlike tramadol, codeine can also be used as a cough suppressant.

    Is tramadol an opiate?

    Yes. Tramadol is an opiate narcotic. It is synthetically made and is in the same drug class as other opioid pain relievers. As a Schedule IV drug, it has less potential for abuse and dependence compared to other opioids.

    Is hydrocodone an opioid?

    Yes. Hydrocodone is an opioid. It is a semi-synthetic opioid that has similar effects to other natural opioids like morphine or codeine.

     

    instructions for use, analogs, composition, indications

    The frequency of possible side effects is classified as follows:

    Very often ( 1/10)

    Often ( 1/100 to <1/10)

    Uncommon ( 1/1000 to <1/100)

    Rarely ( 1/10000 to <1/1000)

    Very rare (<1/10000)

    Unknown (frequency cannot be estimated from available data).

    The most common side effects that can occur during tramadol treatment are nausea and dizziness, which occurs more often than 1 in 10 patients.

    On the part of of the cardiovascular system : infrequently: palpitations, weakness, vascular collapse. These side effects can occur especially in an upright position and during exercise. Rare: bradycardia, arterial hypertension.

    From the side of the central nervous system: very often: dizziness; often: headache; rare: impaired coordination, fainting, speech disorders, changes in appetite, paresthesias, tremors, decreased breathing, epileptic seizures.

    If the recommended dose of the drug is exceeded or other drugs are taken together with tramadol, which reduce the activity of the central nervous system, a decrease in respiratory function is possible.

    Epileptiform seizures were observed mainly after the administration of high doses of tramadol or after the simultaneous use of drugs that can provoke the onset of seizures or lower the seizure threshold.

    From the side of the psyche: rarely: hallucinations, confusion, insomnia and nightmares.

    Mental disorders can vary in manifestation (depending on the personality and duration of drug use).These can be changes in mood (usually high spirits, sometimes irritability), changes in cognitive and sensory abilities (changes in sensory perception and consciousness, which can lead to errors in decision-making).

    Addiction, abuse, and withdrawal reactions are possible. Withdrawal reactions after discontinuation of the drug are typical for opiates and include: agitation, anxiety, nervousness, insomnia, hyperkinesia, tremors, gastrointestinal symptoms.Very rarely, there are attacks of panic, anxiety, hallucinations, paresthesia, tinnitus, confusion, delirium, depersonalization, loss of a sense of reality, paranoia.

    From the side of the organ of vision: rarely: visual impairment, miosis, mydriasis.

    From the gastrointestinal tract: very often: nausea; often: vomiting, constipation, dry mouth; infrequently: diarrhea, stomach problems (eg, fullness, flatulence).

    From the respiratory system and mediastinal organs: rarely: shortness of breath, respiratory depression; unknown: worsening of existing asthma, although causation has not been established.

    On the part of the skin: often: sweating; infrequently: itching, rash, redness of the skin.

    From the musculoskeletal system: rarely: decrease in muscle strength.

    From the liver and biliary tract: very rare: increased transaminases.

    From the side of of the urinary system: rarely: difficulty urinating, dysuria, urinary retention.

    Reproductive system disorders: unknown: decreased libido, impotence, erectile dysfunction, absence of menstruation, infertility. In the event of the development of these adverse reactions, it is necessary to assess the level of sex hormones.

    Other: rare: allergic reactions (such as shortness of breath, wheezing, swelling of the skin) and shock reactions (sudden circulatory failure).

    While taking tramadol with serotonergic drugs, you should immediately consult a doctor if the following symptoms develop: agitation, hallucinations, heart palpitations, fever, increased sweating, chills or tremors, muscle twitching (muscle cramps) or stiffness (stiffness), lack of coordination, nausea, vomiting, or diarrhea (seesection “Precautions” – Serotonin syndrome ).

    In the event of the above adverse reactions or adverse reactions not listed in these instructions, you should consult a doctor.

    Tramal® retard (extended-release tablets)

    The most common adverse reactions are nausea and dizziness, noted in more than 10% of patients.

    The frequency is defined as follows:

    Very often: ≥1 / 10;

    Often: ≥1 / 100, <1/10;

    Uncommon: ≥1 / 1000, <1/100;

    Rarely: ≥1 / 10,000, <1/1000;

    Very rare: <1/10 000;

    Frequency unknown: cannot be determined from the available data.

    Cardiac disorders:

    Uncommon: effect on cardiovascular regulation (palpitations, tachycardia).These adverse reactions are mainly observed with intravenous administration of the drug or with significant physical exertion.

    Rare: bradycardia.

    Vascular disorders:

    Uncommon: effects on cardiovascular regulation (orthostatic hypotension or collapse). These adverse reactions are mainly observed with intravenous administration of the drug or with significant physical exertion.

    Rare: increased blood pressure.

    Metabolic and nutritional disorders:

    Rare: changes in appetite.

    Disorders of the respiratory system, chest and mediastinal organs:

    Rare: respiratory depression, shortness of breath.

    If the recommended doses are significantly exceeded with the simultaneous use of other drugs that depress the central nervous system (CNS), respiratory depression is possible.

    There was a worsening of the condition in bronchial asthma, however, a causal relationship with the use of the drug was not established.

    Nervous system disorders:

    Very common: dizziness.

    Often: headache, drowsiness.

    Rarely: speech disorders, paresthesias, tremors, epileptiform seizures, involuntary muscle contractions, impaired coordination, fainting.

    Epileptiform seizures are possible after the use of high doses of tramadol and with simultaneous use with drugs that lower the seizure threshold.

    Mental disorders:

    Rare: hallucinations, confusion, sleep disturbances, anxiety, delirium and nightmares.After the use of tramadol, various rarely observed undesirable reactions from the psyche are possible (depending on the personal characteristics of the patient and the duration of treatment). These adverse reactions include changes in mood (usually euphoria, sometimes dysphoria), changes in activity (usually decrease, sometimes increase), cognitive and perceptual impairment (eg, decision-making, perception disorders). The development of drug dependence is possible. Possible withdrawal symptoms are similar to those with opioid withdrawal: agitation, anxiety, nervousness, sleep disturbances, hyperkinesia, tremors, and gastrointestinal symptoms.Other symptoms that are very rare when tramadol is discontinued include: panic attacks, severe anxiety, hallucinations, paresthesias, ringing in the ears, and other CNS symptoms (confusion, hallucinations, depersonalization, derealization, paranoia).

    Visual disorders:

    Rare: miosis, mydriasis, blurred vision.

    Disorders from the gastrointestinal tract:

    Very common: nausea.

    Often: constipation, dry mouth, vomiting.

    Uncommon: vomiting, gastrointestinal symptoms (eg, abdominal pain, bloating), diarrhea.

    Skin and subcutaneous tissue disorders:

    Often: sweating.

    Uncommon: skin reactions (eg, itching, redness, urticaria).

    Musculoskeletal and connective tissue disorders:

    Rare: muscle weakness.

    Liver and biliary tract disorders:

    In some cases, there was an increase in the activity of liver enzymes, which coincided in time with tramadol therapy.

    Renal and urinary tract disorders:

    Rare: urinary disorders (dysuria and urinary retention).

    Immune system disorders:

    Rare: allergic reactions (shortness of breath, bronchospasm, wheezing, angioedema) and anaphylaxis.

    General disorders and disorders at the injection site:

    Often: fatigue.

    Laboratory and instrumental data:

    Frequency unknown: hypoglycemia.

    If you experience adverse reactions specified in the instructions, or if you notice other adverse reactions that are not specified in the instructions, inform your doctor.

    Tramadol for osteoarthritis | Cochrane

    This Cochrane Review summary presents what we know from research about the effects of tramadol on osteoarthritis. The review shows that:

    There is a gold level of evidence that for the treatment of osteoarthritis, taking tramadol for up to three months can reduce pain, stiffness, and improve function and well-being in general.Tramadol can cause side effects such as nausea, vomiting, dizziness, constipation, fatigue, and headache.

    The benefits of tramadol are negligible and the side effects may cause people to stop taking it, which may limit the benefits of tramadol in the treatment of osteoarthritis.

    What is osteoarthritis and what medications are used to treat it?

    Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders, and knees.In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. There are two main types of drug treatments for OA. Pain relievers (such as acetaminophen / paracetamol and opioids) are used to relieve pain, but they do not affect swelling. Non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen and COX-II inhibitors) are used to reduce pain and swelling. Tramadol is one of the most used opioids for OA. It does not cause bleeding from the stomach and intestines, nor does it cause kidney problems that can occur with other pain relievers.It also does not affect the cartilage at the ends of the bones. But tramadol does not relieve swelling and may not be effective with long-term use. Therefore, it is important to know the benefits and harms of tramadol.

    What are the results of this review?

    People in the studies took about 200 mg of tramadol per day, or a placebo (counterfeit pill or powder), or NSAIDs, or other pain relievers. People took the medication for one week to three months.

    Benefits of tramadol

    in people with osteoarthritis:

    tramadol may reduce pain more than placebo

    – when taking tramadol, pain can be reduced by more than 8.5 points on a scale from 0 to 100

    tramadol may improve overall well-being more than placebo

    – 50 out of 100 people may improve with placebo
    – 69 out of 100 people may improve with tramadol

    tramadol may slightly reduce stiffness and improve function more than placebo

    – function can improve by 0.32 points on a scale from 0 to 10 when taking tramadol

    It is not known whether tramadol improves symptoms of osteoarthritis more than other medications.It is also unknown if tramadol is still effective with long-term use. This is because the observations in the studies were short.

    Harm of tramadol
    90,271 in people with osteoarthritis:

    tramadol may cause minor side effects in more people than placebo, such as nausea, vomiting, dizziness, constipation, fatigue and headache

    – 18 out of 100 people may have minor side effects with a placebo
    – 39 out of 100 people may have minor side effects with tramadol

    tramadol can cause serious side effects that would cause people to stop taking it

    – 8 out of 100 people had serious side effects with a placebo
    – 21 out of 100 people had serious side effects with tramadol

    It is not known if tramadol causes more side effects than other drugs for osteoarthritis.

    Prescribing anesthetic therapy

    Pain is an unpleasant sensation and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

    The patient has the right to relieve pain associated with the disease and (or) medical intervention, available methods and drugs (clause 5 of article 19 of the Federal Law of November 21, 2011 No. 323-FZ “On the basics of protecting the health of citizens in the Russian Federation “).

    Pain management should be based on the principles of the World Health Organization (WHO ladder of pain relief).

    • Stage 1 – mild pain. Analgin, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs: diclofenac, dexketoprofen, ketoprofen, lornoxicam, etc.) are used.
    • Stage 2 – moderate pain. The weak opioid analgesic tramadol is used. Tramadol is not a drug, it combines the action of a pain reliever and an antidepressant.In older people, it can cause anxiety, agitation, high blood pressure. If it is impossible to take tablets or intolerance to tramadol, use fentanyl in the form of a patch or prosidol (sublingual tablets) or morphine tablets.
    • Stage 3 – severe and unbearable pain. Morphine (usually in extended-release tablets) or a fentanyl patch is given. If they are ineffective, it is advisable to inject morphine and omnopon subcutaneously.

    For all questions regarding the state of health and treatment, the procedure for providing the necessary drugs, first of all, you should contact your doctor.In controversial cases, the head of the department, the deputy chief physician for the medical part will help.

    The patient (or his authorized representative) goes to the clinic or calls a doctor at home. A healthcare professional examines a patient on an outpatient basis or at home, prescribes a drug, and writes a prescription.

    A patient (or trusted person) receives a drug from a pharmacy with a concessional or regular prescription.

    With an increase in pain in patients receiving routine symptomatic treatment (pain relief):

    • if it is impossible to inject yourself, anesthesia is carried out by an ambulance team with a narcotic drug from the patient, which he received on a doctor’s prescription;
    • if the pain syndrome is not relieved by non-narcotic anesthetics, anesthesia is carried out with a narcotic drug by the ambulance team (subparagraph “b” of paragraph 13 of the Procedure for providing ambulance, including specialized medical care, approved by order of the Ministry of Health of the Russian Federation of 20.06.2013 No. 388n).

    Prescription and prescription of drugs in the provision of primary health care is carried out by a medical worker, based on the severity and nature of the disease.

    • Citizens with a disability group and retained the right in terms of preferential drug provision have the right to receive drugs by prescription free of charge, according to the list approved by the order of the Government of the Russian Federation dated 26.12.2015 No. 2724-r.
    • in the absence of a disability group, a citizen with an established oncological disease has the right to write a preferential prescription if there is a medical indication for a regional benefit.

    You can call the Hotline for the provision of analgesic therapy:

    Medicines for life: how to get a prescription for strong painkillers

    October 28, 2016, 13:54

    Pain is one of the main symptoms that cause suffering in malignant neoplasms and not only.

    “Pain is an unpleasant sensation and emotional experience associated with real or potential tissue damage, or described in terms of such damage.”

    The patient has the right to relieve pain associated with the disease and (or) medical intervention, available methods and drugs (clause 5 of article 19 of the Federal Law of 21.11.2011, No. 323-FZ “On the basics of protecting the health of citizens in Russian Federation”).

    Only the patient himself knows everything about his pain.Only together with the patient can the doctor develop a treatment plan and evaluate its effectiveness. Tell the doctor where your pain is, what the nature of the pain is (sharp, pulling, burning) and how intense your pain is.

    Pain management should be based on the principles of the World Health Organization (WHO ladder of pain relief).

    Stage 1 – mild pain. Analgin, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs: diclofenac, desketoprofen, ketoprofen, lornoxicam and others) are used.

    Stage 2 – moderate pain. A weak opioid analgesic is used – tramadol. Tramadol is not a drug, it combines the action of an analgesic and an antidepressant. In older people, it can cause anxiety, agitation, high blood pressure. If it is impossible to take pills or intolerance to tramadol, use fentanyl in the form of a patch or prosidol (sublingual tablets) or morphine tablets.

    Stage 3 – severe and unbearable pain.Morphine (usually in extended-release tablets) or a fentanyl patch is given. If they are not effective, it is advisable to inject morphine and omnopon subcutaneously.

    Where to go if you have severe pain!

    For all questions related to the state of health and treatment, the procedure for providing the necessary drugs, first of all, you must contact your doctor (district general practitioner, general practitioner, family doctor, palliative care doctor).

    In disputable cases, the head of the department, the deputy chief physician for the medical part, the person responsible for preferential drug provision in the organization will help.

    Where can health care be provided to relieve, treat and prevent pain?

    The patient (or his authorized representative) goes to the clinic or calls a doctor at home. A healthcare professional examines a patient on an outpatient basis or at home, prescribes a drug, and writes a prescription.

    The patient (or proxy) receives the drug at the pharmacy with a concessional or regular prescription.

    In case of increased pain in patients receiving routine symptomatic treatment (anesthesia):

    if it is impossible to inject on their own, anesthesia is carried out by a mobile ambulance team with a narcotic drug from a patient received by him on a doctor’s prescription;

    if the pain syndrome is not relieved by non-narcotic anesthetics, anesthesia is carried out with a narcotic drug by an ambulance team (subparagraph “b” of paragraph 13 of the Procedure for providing an ambulance, including specialized medical care approved by order of the Ministry of Health of the Russian Federation of 20.06.2013 No. 388n).

    Can a citizen with cancer get pain relievers free of charge?

    Prescription and prescription of drugs in the provision of primary health care is carried out by a medical worker, based on the severity and nature of the disease.

    Citizens with a disability group and retained the right in terms of preferential drug provision have the right to receive drugs by prescription free of charge, according to the list approved by the order of the Government of the Russian Federation dated 26.12.2015 No. 2724-r.

    in the absence of a disability group, a citizen with an established oncological disease has the right to write a preferential prescription if there is a medical indication for a regional benefit.

    Where can I find lists of free drugs?

    in the office of the attending physician;

    at the information stand of a medical organization;

    on the website of the Ministry of Health of the Nizhny Novgorod Region.

    ATTENTION!

    According to the provisions of the Federal Law of December 31, 2014 No. 501-FZ “On Amendments to the Federal Law” On Narcotic Drugs and Psychotropic Substances “:

    The validity period of a special prescription for narcotic drugs and psychotropic substances is 15 days !!! (previously it was 5 days)

    Medical workers do not have the right to demand used packages of narcotic painkillers (ampoules and plasters) when issuing a repeated prescription (Art.5 FZ No. 501-FZ dated December 31, 2014).

    If the issues on pain relief remain unresolved!

    the patient can go to the website of the medical organization to which he is attached according to the territorial principle, where information is posted on the provision of anesthetic therapy for relief of pain syndrome of any nature in patients, indicating for citizens the phone number, email address, surname, first name, patronymic, position of the person responsible for this section of work for obtaining information and filing complaints;

    Call the hotline for analgesic therapy:

    Ministry of Health of the Nizhny Novgorod Region – from 09:00 to 18:00 on a daily basis, except weekends and holidays – by phone: 8 (831) 435 32 12;

    GBUZ NO “Ambulance stationNizhny Novgorod “- from 18:00 to 09:00, on weekends and holidays, call the operational duty officer: 8 (831) 428 62 52;

    GBUZ NO “Nizhny Novgorod Territorial Center for Disaster Medicine” – from 18:00 to 09:00, on weekends and holidays, call the operational duty officer: 8 (831) 250 94 02.

    Memorial Sloan Kettering Cancer Center

    This document, provided by Lexicomp ® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

    Trade names: USA

    ConZip; Qdolo; Ultram

    Trade names: Canada

    APO-Tramadol; AURO-Tramadol; Durela; JAMP Tramadol; MAR-Tramadol; Ralivia; SANDOZ Tramadol; TARO-Tramadol ER; Tridural; Ultram [DSC]; Zytram XL

    Warning

    For all patients taking this drug:

    • This medicine is a powerful pain reliever that can be addictive, abuse or misuse.Misuse or abuse of this drug can lead to overdose and death. Please consult your doctor.
    • You will be closely monitored to avoid misuse, abuse or dependence on this drug.
    • This drug may cause very bad and sometimes deadly breathing problems. Call a doctor right away if breathing is slow, shallow, or difficult.
    • The risk of serious and sometimes fatal respiratory problems may be increased when this drug is started or if the dose is increased.
    • Even one dose of this drug, taken by another person or by mistake, can be deadly, especially in children. If this drug has been taken by another person or by mistake, get medical help right away.
    • Store all medicines in a safe place.Keep all medicines out of the reach of children and pets.
    • Long-term use of this drug during pregnancy may cause withdrawal in newborns. This can be life threatening. Consult your doctor.
    • This medicinal product contains an opioid. Serious side effects have occurred with the use of opioid drugs with benzodiazepines, alcohol, marijuana, or other forms of cannabis, as well as prescription or over-the-counter drugs that can cause drowsiness or slow action.These effects include slowed down or labored breathing and death. Benzodiazepines include drugs such as alprazolam, diazepam, and lorazepam. Benzodiazepines can be used to treat many health conditions such as anxiety, sleep disturbances, or seizures. If you have any questions, please consult your doctor.
    • Many drugs interact with this drug, which can increase the risk of side effects, such as deadly breathing problems.Check with your doctor and pharmacist to make sure this drug is safe to use with all your other drugs.
    • Do not take with alcohol or foods containing alcohol. Dangerous, sometimes deadly, effects can develop.
    • Get immediate medical attention if you feel very sleepy, dizzy, or pass out. Caregivers or others should seek immediate medical attention if the patient does not respond, does not respond, or does not respond in the usual way, or if he is asleep and does not wake up.

    Children:

    • This drug is not approved for use in children. Do not give to children under 12 years of age. This drug should not be taken by children between the ages of 12 and 18 who are very overweight or have some other health problem, incl. sleep apnea or other lung or breathing problems. If your child has received this drug, ask the doctor about the benefits and risks.
    • The use of tramadol after surgery to remove tonsils or adenoids has resulted in very severe and sometimes fatal breathing problems in some children.Do not give this drug to a child younger than 18 years old who has had tonsillitis or adenoid surgery. Check with your child’s doctor.

    All liquid preparations:

    • Make sure you know how to measure your dose. Dosing error can lead to accidental overdose and death. If you have questions, ask your doctor or pharmacist.

    What is this drug used for?

    • Used to relieve pain.

    What do I need to tell my doctor BEFORE taking this drug?

    • If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.
    • If you have any of the following health conditions: Lung or breathing problems such as bronchial asthma, difficulty breathing, or sleep apnea; high levels of carbon dioxide in the blood; gastrointestinal obstruction or narrowing.
    • If you have any of the following health conditions: kidney disease or liver disease.
    • If you have suicidal thoughts, or have previously abused alcohol or other drugs, or suffered from drug / drug or alcohol dependence.
    • If your doctor has told you that the metabolism of certain drugs is accelerated in your body.
    • If you have recently drunk large amounts of alcohol or have taken a large number of drugs that slow your reaction rate, such as phenobarbital, or some pain relievers, such as oxycodone.
    • If you are taking carbamazepine.
    • If you are taking another drug that contains the same drug.
    • If you are taking any of the following drugs: buprenorphine, butorphanol, linezolid, methylene blue, nalbuphine, or pentazocine.
    • If you have taken a drug for depression or Parkinson’s disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline.An episode of very high blood pressure may occur.
    • If you are breastfeeding. Do not breast-feed while taking this drug.

    This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

    Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems.You need to make sure that this drug is safe for your medical condition and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.

    What do I need to know or do while taking this drug?

    • Tell all healthcare providers that you are taking this drug.These are doctors, nurses, pharmacists and dentists.
    • Avoid driving or other activities that require special attention until you see how this drug is affecting you.
    • To reduce the risk of dizziness or loss of consciousness, get up slowly from a lying or sitting position. Use caution when climbing and descending stairs.
    • Do not take the drug in higher doses than your doctor has prescribed. Taking more than the prescribed amount of the drug increases the risk of serious side effects.
    • Do not take this drug with any other strong pain reliever or with a pain reliever patch without first talking to your doctor.
    • This drug may increase the risk of seizures. The risk may be increased in people with certain health problems, in those using certain other drugs, or in alcohol abuse. Talk to your doctor to find out if you are at increased risk of seizures while taking this drug.
    • If this drug is taken for a long time or in high doses, its effectiveness may be reduced and a higher dose may be needed to obtain the same effect. The so-called drug tolerance develops. Talk to your doctor if this drug stops working. Do not take the drug in higher doses than your doctor prescribed.
    • Low blood sugar has happened with this drug.In some cases, hospitalization was required. Call your doctor right away if you develop symptoms of low blood sugar, such as dizziness, headache, drowsiness or weakness, tremors, tachycardia, confusion, hunger, or sweating.
    • Long-term or regular use of opioid drugs like this one can lead to dependence. Reducing the dose or stopping suddenly from this drug can cause a serious risk of a withdrawal reaction or other serious disturbance.Talk to your doctor before lowering the dose or stopping this drug. Follow your doctor’s instructions. Tell your doctor if you experience severe pain, mood changes, suicidal thoughts, or any other side effects.
    • Long-term use of an opioid drug can lead to a decrease in sex hormone levels. If you have a decreased interest in sex, impaired fertility, missing menstrual periods, or trouble ejaculating, see your doctor.
    • Occasionally, this type of opioid can cause very severe adrenal dysfunction. Call your doctor right away if you experience very severe dizziness or fainting, very severe nausea or vomiting, decreased appetite, feeling very tired or weak.
    • If you are 65 years of age or older, use this drug with caution. You may have more side effects.
    • If used during pregnancy, the drug may have a harmful effect on the fetus.If you are pregnant or become pregnant while taking this drug, call your doctor right away.

    What side effects should I report to my doctor immediately?

    WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

    • Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.In rare cases, certain allergic reactions have resulted in death.
    • Signs of depression, suicidal thoughts, ups and downs, thought disorders, anxiety or lack of interest in life.
    • Signs of low sodium levels such as headache, trouble concentrating, memory impairment, confusion, weakness, seizures, balance problems.
    • Severe dizziness or fainting.
    • Confusion of consciousness.
    • Convulsions.
    • Chest pain or pressure or heart palpitations.
    • Urinary tract obstruction.
    • Frequent urination.
    • Difficulty breathing, slow or shallow breathing.
    • Noisy breathing.
    • Disturbed breathing during sleep (sleep apnea syndrome).
    • Change in vision.
    • Severe constipation or abdominal pain. These may be signs of a severe bowel disorder.
    • A serious and sometimes fatal complication called serotonin syndrome may occur.This risk may increase with the concomitant use of certain other drugs. Call your doctor right away if you develop agitation, imbalance, confusion, hallucinations, fever, tachycardia or irregular heartbeat, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting , very severe headache.
    • Possible severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis).This can lead to serious and permanent health problems and sometimes death. Get immediate medical attention if you experience symptoms such as redness, skin swelling with blistering or scaling (with or without a high fever), redness or irritation of the eyes, and ulceration in the mouth, throat, nose, or eyes.

    What are some other side effects of this drug?

    Any medicine can have side effects.However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

    • Feeling dizzy, sleepy, tired, or weak.
    • Constipation, diarrhea, vomiting or nausea.
    • Dry mouth.
    • Headache.
    • Itching.
    • Sleep disorders.
    • Hyperemia (blush).
    • Excessive sweating.

    This list of potential side effects is not comprehensive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

    You can report side effects to the National Health Office.

    You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

    What is the best way to take this drug?

    Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

    All forms of issue:

    • Take by mouth only.
    • This drug must not be given by injection or inhaled through the nose. Any of these actions can lead to very serious side effects such as breathing difficulties and death from overdose.

    All liquid dosage forms and tablets:

    • Take with or without food. Take with food if the medicine causes nausea.

    All liquid preparations:

    • Care should be taken to measure liquid doses. Use the dispenser that comes with the medicine. If a dispenser is not included in the package, ask your pharmacist for a dosing product for this drug.
    • This medication should not be measured with a regular teaspoon or tablespoon.This can lead to exceeding the dose of the drug.

    Liquid (suspension):

    • Shake well before use.

    All sustained release formulations:

    • Swallow whole. Do not chew, break, grind, or dissolve before swallowing. These actions can cause very serious side effects and death.
    • Take this drug with or without food.Some medications need to be taken the same way each time, either with food or separately from food. You need to know for sure if the intake of this drug is food-dependent. If you have any doubts about whether the intake of a drug is food-dependent, consult your doctor or pharmacist.
    • Take this drug at about the same time of the day.
    • Do not use this medicine for immediate pain relief or as needed.
    • This drug should not be used to relieve pain after surgery if you have not previously taken this type of drug.
    • Consult your doctor if you have difficulty swallowing.

    What to do if a dose of a drug is missed?

    • Take the missed dose as soon as you can.
    • If it is time for your next dose, do not take the missed dose and then return to your normal dose.
    • Do not take 2 doses at the same time or an additional dose.
    • Some drugs are taken to relieve pain as needed.If you are taking this drug as needed, do not do it more often than your doctor has recommended.

    How do I store and / or discard this drug?

    All forms of issue:

    • Store at room temperature in a dry place. Do not store in the bathroom.
    • Store this medication in a secure place, out of the reach of children, and out of the reach of others. A box or room, which is locked with a key, can act as a protected storage location for the drug.Keep all medicines out of the reach of pets.
    • Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

    Liquid (suspension):

    • Check the storage time of this drug before you need to throw it away.

    General information about medicines

    • If your health does not improve or even worsens, see your doctor.
    • Do not give your medicine to anyone or take other people’s medicines.
    • Some medicines may come with other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
    • A separate patient instruction sheet is attached to the product. Please read this information carefully. Reread it every time you replenish your supply. If you have questions about this drug, talk with your doctor, pharmacist, or other healthcare professional.
    • A drug called naloxone can be used to treat an overdose with this drug. Your doctor may prescribe naloxone to keep you with you while you are taking this drug.If you have any questions about buying or using naloxone, ask your doctor or pharmacist. If you think an overdose has occurred, seek immediate medical attention, even if you are using naloxone. Be prepared to tell or show which drug you took, how much and when it happened.

    Consumer use of information and limitation of liability

    This information should not be used to make decisions about taking this or any other drug.Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug.This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional. For complete information on the possible risks and benefits of taking this drug, consult your doctor. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

    Copyright

    © UpToDate, Inc.and its affiliates and / or licensors, 2021. All rights reserved.

    90,000 “Islamic State” left without “wheels” – Mir – Kommersant

    Italian tax police, together with customs, seized 37 tons of pain reliever tramadol intended for Islamic State (IS; banned in Russia) militants in Libya. The cargo, worth € 75 million, was packed into three shipping containers and labeled as blankets and shampoo.

    Tramadol (other trade names are captagon, contramal, tramolin, etc.)) Is an opioid analgesic, usually used as a pain reliever, can relieve tiredness and hunger. In many countries, it is included in the list of narcotic drugs, in some, for example, in Russia, it is included in the list of essential drugs and is sold exclusively by prescription. It is also sometimes called the “militant drug”: there is ample evidence of its use by terrorists in Europe, in the Gaza Strip, in Nigeria. It was this drug that was seized by the Italian tax police during a joint operation with the customs office in the port of Genoa.Three shipping containers, lightly covered with blankets and shampoos, contained 37 million tramadol tablets with a total weight of about 37 tons. The containers marked “Blankets” and “Shampoos” were being prepared for shipment to the Libyan cities of Misurata and Tobruk and, as Italian experts believe, were intended for IS militants.

    Italian police traced this cargo all the way to Italy.The tablets were produced by the Indian pharmaceutical company Royal International (in India, this drug is not a drug). Then they were allegedly bought for $ 250 thousand by an importing company from Dubai, after which the entire consignment was delivered by sea from India to Sri Lanka. Further, the mention of this cargo disappears from all documents of the company transporting tramadol. “The containers were shipped to Genoa to be delivered to two companies in Libya. These companies, as the US Drug Enforcement Administration has warned us, are linked to IS, ”The Times quotes one of the Italian investigators, who did not want to give his name.According to him, these pills “are addictive, but at the same time they are much cheaper than cocaine or amphetamines. So someone makes a fortune on this. ”

    “Tramadol is often used as a drug, especially in the Middle East,” the Genoa tax police said in a statement. € 2 “. According to Italian law enforcement agencies, the proceeds from the sale of tramadol would go to finance Islamic terrorism.Commenting on the joint law enforcement operation, Genoa prosecutor Francesco Cozzi said: “It is important to note the clear and well-coordinated work of the customs and tax police officers. The port of Genoa is located on an extremely difficult section, where many paths intersect – it is worth remembering, for example, the cargo of weapons that followed through us to Libya. The main task is to make it clear that nothing will pass through Genoa that can enrich or help terrorist organizations. ”

    Alena Miklashevskaya

    .