Tramadol drug interactions

List of drug interactions
Use with Carbamazepine Use with Quinidine Use with Inhibitors of CYP2D6 Use with Cimetidine Use with MAO Inhibitors Use with Digoxin Use with Warfarin Like Compounds

Use with Carbamazepine
Patients taking carbamazepine may have a significantly reduced analgesic effect of tramadol. Because carbamazepine increases tramadol metabolism and because of the seizure risk associated with tramadol concomitant administration of Tramadol and carbamazepine is not recommended. Return to top

Use with Quinidine
Tramadol is metabolized to M1 by CYP2D6. Quinidine is a selective inhibitor of that isoenzyme; so that concomitant administration of quinidine and tramadol results in increased concentrations of tramadol and reduced concentrations of M1. The clinical consequences of these findings are unknown. In vitro drug interaction studies in human liver microsomes indicate that tramadol has no effect on quinidine metabolism. Return to top

Use with Inhibitors of CYP2D6
In vitro drug interaction studies in human liver microsomes indicate that concomitant administration with inhibitors of CYP2D6 such as fluoxetine, paroxetine, and amitriptyline could result in some inhibition of the metabolism of tramadol. Return to top

Use with Cimetidine
Concomitant administration of Tramadol and cimetidine has not been studied. Concomitant administration of tramadol and cimetidine does not result in clinically significant changes in tramadol pharmacokinetics. Therefore, no alteration of the Tramadol dosage regimen is recommended. Return to top

Use with MAO Inhibitors
Interactions with MAO Inhibitors, due to interference with detoxification mechanisms, have been reported for some centrally acting drugs. Return to top

Use with Digoxin
Post-marketing surveillance of tramadol has revealed rare reports of digoxin toxicity. Return to top

Use with Warfarin Like Compounds
Post-marketing surveillance of both tramadol and acetaminophen individual products have revealed rare alterations of warfarin effect, including elevation of prothrombin times. While such changes have been generally of limited clinical significance for the individual products, periodic evaluation of prothrombin time should be performed when Tramadol and warfarin-like compounds are administered concurrently. Return to top