Dosing & Uses
Dosage Forms & Strengths
tablet, immediate-release: Schedule IV
- 50mg (Ultram, generic)
- 100mg (generic)
capsule, extended release: Schedule IV
- 100mg (ConZip)
- 150mg (ConZip)
- 200mg (ConZip)
- 300mg (ConZip)
solution, oral: Schedule IV
- 5mg/mL (Qdolo)
- Equivalent to tramadol 4.4 mg/mL
Pain
Indicated for moderate-to-severe pain management in adults which alternative therapies are inadequate
Initiate dosing regimen for each patient individually, taking into account the patient's severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse
Immediate release
- Chronic: 25 mg PO every morning initially; increased by 25-50 mg/day every 3 days up to 50-100 mg PO q4-6hr PRN; not to exceed 400 mg/day
- Acute: 50-100 mg PO q4-6hr PRN; not to exceed 400 mg/day
Extended release
- 100 mg PO once daily initially; increased by 100 mg/day every 5 days; not to exceed 300 mg/day
-
Conversion from immediate release to extended release
Round total daily dose down to nearest 100 mg; titrate subsequent dose base on individual need
Oral solution
- 25 mg/day PO initially; may titrate in 25-mg increments as separate doses every 3 days to 100 mg/day (25 mg QID), THEN
- May increase total daily dose by 50-mg increments as tolerated every 3 days to 200 mg/day (50 mg QID)
- After titration, 50-100 mg q4-6 hr PRN for pain relief, not to exceed 400 mg/day
- For rapid onset of analgesic effect and benefits outweigh risks of discontinuation due to adverse events associated with high initial doses: 50-100 mg q4-6 hr PRN for pain relief, not to exceed 400 mg/day
Dosage Modifications
Renal impairment
- CrCl ≥30 mL/minute: No dosage adjustments necessary; use with caution
-
Severe (CrCl <30 mL/min)
- Oral solution: Increase dosing interval to q12hr, not to exceed 200 mg/day
- Immediate release: 50-100 mg PO q12hr
- Extended release: Not recommended
-
Patients on dialysis
- May receive regular dose on dialysis days; only 7% of dose is removed by hemodialysis
Hepatic impairment
- Mild-to-moderate: No dosage adjustments necessary; use with caution
-
Severe
- Oral solution and immediate release: 50 mg PO q12hr
- Extended release: Not recommended
Dosing Considerations
Closely monitor for respiratory depression, especially within the first 24–72 hr of initiating therapy and following dosage increases and adjust dosage accordingly
Do not use concomitantly with other tramadol-containing products
Access to naloxone for opioid overdose
- Assess need for naloxone upon initiating and renewing treatment
-
Consider prescribing naloxone
- Based on patient’s risk factors for overdose (eg, concomitant use of CNS depressants, a history of opioid use disorder, prior opioid overdose); presence of risk factors should not prevent proper pain management
- Household members (including children) or other close contacts at risk for accidental ingestion or overdose
-
Consult patients and caregivers on the following:
- Availability of naloxone for emergency treatment of opioid overdose
- Ways to obtain naloxone as permitted by individual state dispensing and prescribing requirements or guidelines (eg, by prescription, directly from a pharmacist, as part of a community-based program)
Discontinuation
- Do not abruptly discontinue in patients who may be physically dependent on opioids
- Rapid discontinuation of opioid analgesics has resulted in serious withdrawal symptoms, uncontrolled pain, and suicide
- For physically opioid-dependent: Initiate small increment taper (eg, ≥10-25% of total daily dose) to avoid withdrawal symptoms, and proceed with decreasing the dose every 2-4 weeks
- Patients who have been taking opioids for shorter periods of time may tolerate a more rapid taper
Limitations of use
-
Owing to risks of addiction, abuse, and misuse with opioids, reserve use in patients for whom alternative treatment options [eg, non-opioid analgesics]
- Are not or not expected to be tolerated
- Have not or are not expected to provide adequate analgesia
HIV-Associated Neuropathy (Orphan)
Orphan indication sponsor
- TheraQuest Biosciences, LLC, 146 Medinah Drive, Blue Bell, PA 19422-3212
Postherpetic Neuralgia (Orphan)
Orphan indication sponsor
- TheraQuest Biosciences, LLC, 146 Medinah Drive, Blue Bell, PA 19422-3212
Safety and efficacy not established
Life-threatening respiratory depression and death have occurred in children who received tramadol
Tramadol is subject to variability in metabolism based upon CYP2D6 genotype, which can lead to increased exposure to an active metabolite
Pain
>65 years: Initiate at lower end of dosing range; not to exceed 300 mg/day if >75 years
>75 years
- Immediate release or oral solution: Not to exceed 300 mg/day
- Extended release: Use with caution
Dosage Modifications
Renal impairment
- CrCl ≥30 mL/minute: No dosage adjustments necessary; use with caution
-
Severe (CrCl <30 mL/min)
- Oral solution: Increase dosing interval to q12hr, not to exceed 200 mg/day
- Immediate release: 50-100 mg PO q12hr
- Extended release: Not recommended
-
Patients on dialysis
- May receive regular dose on dialysis days; only 7% of dose is removed by hemodialysis
Hepatic impairment
- Mild-to-moderate: No dosage adjustments necessary; use with caution
-
Severe
- Oral solution and immediate release: 50 mg PO q12hr
- Extended release: Not recommended
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (5)
- alvimopan
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.
- procarbazine
procarbazine and tramadol both increase serotonin levels. Contraindicated.
- rasagiline
rasagiline and tramadol both increase serotonin levels. Contraindicated.
- safinamide
tramadol, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.
- selegiline
selegiline and tramadol both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of analgesic.
Serious - Use Alternative (74)
- abametapir
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.
- acrivastine
acrivastine and tramadol both increase sedation. Avoid or Use Alternate Drug.
- alfentanil
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.
- amisulpride
amisulpride and tramadol both increase sedation. Avoid or Use Alternate Drug.
- apalutamide
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.
- asenapine transdermal
asenapine transdermal and tramadol both increase sedation. Avoid or Use Alternate Drug.
- belladonna and opium
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.
- benzhydrocodone/acetaminophen
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.
benzhydrocodone/acetaminophen and tramadol both increase sedation. Avoid or Use Alternate Drug. - bremelanotide
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.
- buprenorphine
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
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 subdermal implant
buprenorphine subdermal implant and tramadol both increase sedation. Avoid or Use Alternate Drug.
- butorphanol
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. - calcium/magnesium/potassium/sodium oxybates
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.
- clonidine
clonidine, tramadol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.
- codeine
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.
- cyclobenzaprine
tramadol and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.
- dacomitinib
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.
- desvenlafaxine
tramadol and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
- dextromoramide
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
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 intranasal
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.
- difenoxin hcl
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.
- diphenoxylate hcl
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
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.
- duloxetine
duloxetine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
- eluxadoline
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. .
- fentanyl
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
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
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
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
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.
- givosiran
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.
- hydrocodone
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.
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. - hydromorphone
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.
- idelalisib
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
- iobenguane I 131
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
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. - ivosidenib
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.
- levorphanol
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.
- linezolid
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. - lonafarnib
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.
- lorcaserin
tramadol and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
- meperidine
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.
- methadone
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.
- methylene blue
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.
- metoclopramide intranasal
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.
- morphine
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.
- nalbuphine
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. - olopatadine intranasal
tramadol and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- opium tincture
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.
- oxycodone
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
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
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.
- papaveretum
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.
- pentazocine
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. - phenelzine
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. - posaconazole
posaconazole will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- procarbazine
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. .
- ribociclib
ribociclib will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- secobarbital
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 transdermal
selegiline transdermal increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- selinexor
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.
- sodium oxybate
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.
- sufentanil
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
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.
- tapentadol
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.
- tedizolid
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.
- tranylcypromine
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. - tucatinib
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
valerian and tramadol both increase sedation. Avoid or Use Alternate Drug.
- vilazodone
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.
- vortioxetine
tramadol, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.
- voxelotor
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.
Monitor Closely (297)
- 5-HTP
5-HTP and tramadol both increase serotonin levels. Use Caution/Monitor.
- abiraterone
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
tramadol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
alfentanil and tramadol both increase sedation. Use Caution/Monitor.
- almotriptan
almotriptan and tramadol both increase serotonin levels. Use Caution/Monitor.
- alprazolam
alprazolam and tramadol both increase sedation. Use Caution/Monitor.
- amifampridine
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
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
tramadol and amitriptyline both increase sedation. Use Caution/Monitor.
amitriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - amobarbital
amobarbital and tramadol both increase sedation. Use Caution/Monitor.
- amoxapine
tramadol and amoxapine both increase sedation. Use Caution/Monitor.
amoxapine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - apomorphine
tramadol and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
tramadol increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
tramadol and aripiprazole both increase sedation. Use Caution/Monitor.
- armodafinil
tramadol increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- artemether/lumefantrine
artemether/lumefantrine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- asenapine
asenapine and tramadol both increase sedation. Use Caution/Monitor.
- atazanavir
atazanavir increases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .
- avapritinib
avapritinib and tramadol both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and tramadol both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and tramadol both increase sedation. Use Caution/Monitor.
- belladonna and opium
belladonna and opium and tramadol both increase sedation. Use Caution/Monitor.
- benperidol
tramadol and benperidol both increase sedation. Use Caution/Monitor.
- benzphetamine
tramadol increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bosentan
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
- brexanolone
brexanolone, tramadol. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and tramadol both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and tramadol both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and tramadol both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and tramadol both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and tramadol both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and tramadol both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
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
bupropion will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- buspirone
buspirone and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- butabarbital
butabarbital and tramadol both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and tramadol both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and tramadol both increase sedation. Use Caution/Monitor.
- caffeine
tramadol increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbamazepine
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
carbinoxamine and tramadol both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and tramadol both increase sedation. Use Caution/Monitor.
- celecoxib
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
cenobamate, tramadol. Either increases effects of the other by sedation. Use Caution/Monitor.
- ceritinib
ceritinib will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and tramadol both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and tramadol both increase sedation. Use Caution/Monitor.
- chloroquine
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
chlorpheniramine and tramadol both increase sedation. Use Caution/Monitor.
- chlorpromazine
tramadol and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and tramadol both increase sedation. Use Caution/Monitor.
- cimetidine
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
cinnarizine and tramadol both increase sedation. Use Caution/Monitor.
- citalopram
citalopram and tramadol both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
- clarithromycin
clarithromycin will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- clemastine
clemastine and tramadol both increase sedation. Use Caution/Monitor.
- clobazam
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
tramadol and clomipramine both increase sedation. Use Caution/Monitor.
clomipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - clonazepam
clonazepam and tramadol both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and tramadol both increase sedation. Use Caution/Monitor.
- clozapine
tramadol and clozapine both increase sedation. Use Caution/Monitor.
- cobicistat
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 topical
cocaine topical and tramadol both increase serotonin levels. Use Caution/Monitor.
- codeine
codeine and tramadol both increase sedation. Use Caution/Monitor.
- crizotinib
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
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
cyclizine and tramadol both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and tramadol both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and tramadol both increase sedation. Use Caution/Monitor.
- dabrafenib
dabrafenib will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dantrolene
dantrolene and tramadol both increase sedation. Use Caution/Monitor.
- daridorexant
tramadol and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- darunavir
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
desflurane and tramadol both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.
- desipramine
tramadol and desipramine both increase sedation. Use Caution/Monitor.
desipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - desvenlafaxine
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 <100 mg
- deutetrabenazine
tramadol and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dexamethasone
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
dexchlorpheniramine and tramadol both increase sedation. Use Caution/Monitor.
- dexfenfluramine
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
dexmedetomidine and tramadol both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
tramadol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
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. - dextroamphetamine transdermal
tramadol, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).
- dextromethorphan
dextromethorphan and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- dextromoramide
dextromoramide and tramadol both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and tramadol both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and tramadol both increase sedation. Use Caution/Monitor.
- diethylpropion
tramadol increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and tramadol both increase sedation. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and tramadol both increase sedation. Use Caution/Monitor.
- dihydroergotamine
dihydroergotamine and tramadol both increase serotonin levels. Use Caution/Monitor.
- dihydroergotamine intranasal
dihydroergotamine intranasal and tramadol both increase serotonin levels. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and tramadol both increase sedation. Use Caution/Monitor.
- diphenhydramine
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
diphenoxylate hcl and tramadol both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and tramadol both increase sedation. Use Caution/Monitor.
- dobutamine
tramadol increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
tramadol increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
tramadol increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
tramadol and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
tramadol and doxepin both increase sedation. Use Caution/Monitor.
doxepin and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - doxylamine
doxylamine and tramadol both increase sedation. Use Caution/Monitor.
- droperidol
tramadol and droperidol both increase sedation. Use Caution/Monitor.
- duloxetine
duloxetine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- efavirenz
efavirenz will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- elagolix
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
eletriptan and tramadol both increase serotonin levels. Use Caution/Monitor.
- eliglustat
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.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
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
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
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
tramadol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
tramadol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
tramadol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ergotamine
ergotamine and tramadol both increase serotonin levels. Use Caution/Monitor.
- erythromycin base
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
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
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
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
escitalopram and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- esketamine intranasal
esketamine intranasal, tramadol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- eslicarbazepine acetate
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
estazolam and tramadol both increase sedation. Use Caution/Monitor.
- ethanol
tramadol and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and tramadol both increase sedation. Use Caution/Monitor.
- etravirine
etravirine will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fedratinib
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
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. - flibanserin
tramadol and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
- fluoxetine
fluoxetine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- fluphenazine
tramadol and fluphenazine both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and tramadol both increase sedation. Use Caution/Monitor.
- fluvoxamine
fluvoxamine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- formoterol
tramadol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fosphenytoin
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
frovatriptan and tramadol both increase serotonin levels. Use Caution/Monitor.
- gabapentin
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
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.
- ganaxolone
tramadol and ganaxolone both increase sedation. Use Caution/Monitor.
- haloperidol
tramadol and haloperidol both increase sedation. Use Caution/Monitor.
- hydromorphone
hydromorphone and tramadol both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and tramadol both increase sedation. Use Caution/Monitor.
- iloperidone
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
tramadol and imipramine both increase sedation. Use Caution/Monitor.
imipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - indinavir
indinavir increases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .
- isoniazid
isoniazid and tramadol both increase serotonin levels. Use Caution/Monitor.
- isoproterenol
tramadol increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- istradefylline
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
itraconazole will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ketamine
ketamine and tramadol both increase sedation. Use Caution/Monitor.
- ketoconazole
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
tramadol and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- L-tryptophan
L-tryptophan and tramadol both increase serotonin levels. Use Caution/Monitor.
- larotrectinib
larotrectinib will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lasmiditan
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
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.
- lenacapavir
lenacapavir will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration of tramadol and lenacapavir may require decrease in dose for tramadol.
- levalbuterol
tramadol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levoketoconazole
levoketoconazole 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
- levomilnacipran
levomilnacipran and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- levorphanol
levorphanol and tramadol both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
tramadol increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
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). - lithium
lithium and tramadol both increase serotonin levels. Use Caution/Monitor.
- lofepramine
tramadol and lofepramine both increase sedation. Use Caution/Monitor.
lofepramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - lofexidine
tramadol and lofexidine both increase sedation. Use Caution/Monitor.
- lopinavir
lopinavir will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- loprazolam
loprazolam and tramadol both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and tramadol both increase sedation. Use Caution/Monitor.
- lorcaserin
lorcaserin will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- lorlatinib
lorlatinib will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lormetazepam
lormetazepam and tramadol both increase sedation. Use Caution/Monitor.
- loxapine
tramadol and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
tramadol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lsd
lsd and tramadol both increase serotonin levels. Use Caution/Monitor.
- lumefantrine
lumefantrine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- lurasidone
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
tramadol and maprotiline both increase sedation. Use Caution/Monitor.
maprotiline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - marijuana
tramadol and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
tramadol and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and tramadol both increase sedation. Use Caution/Monitor.
meperidine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - meprobamate
tramadol and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
tramadol increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and tramadol both increase sedation. Use Caution/Monitor.
- methadone
methadone and tramadol both increase sedation. Use Caution/Monitor.
- methamphetamine
tramadol increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and tramadol both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
tramadol increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
midazolam and tramadol both increase sedation. Use Caution/Monitor.
- midazolam intranasal
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
tramadol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mifepristone
mifepristone will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- milnacipran
milnacipran and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- mirabegron
mirabegron will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- mirtazapine
tramadol and mirtazapine both increase sedation. Use Caution/Monitor.
mirtazapine and tramadol both increase serotonin levels. Use Caution/Monitor. - mitotane
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
tramadol increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
morphine and tramadol both increase sedation. Use Caution/Monitor.
morphine and tramadol both increase serotonin levels. Use Caution/Monitor. - motherwort
tramadol and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
tramadol and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
tramadol and nabilone both increase sedation. Use Caution/Monitor.
- nafcillin
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
nalbuphine and tramadol both increase sedation. Use Caution/Monitor.
- naratriptan
naratriptan and tramadol both increase serotonin levels. Use Caution/Monitor.
- nefazodone
nefazodone and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
nefazodone will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - nelfinavir
nelfinavir increases levels of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .
- nevirapine
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
- norepinephrine
tramadol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
tramadol and nortriptyline both increase sedation. Use Caution/Monitor.
nortriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - olanzapine
tramadol and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
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
opium tincture and tramadol both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and tramadol both increase sedation. Use Caution/Monitor.
- oxazepam
oxazepam and tramadol both increase sedation. Use Caution/Monitor.
- oxcarbazepine
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
oxycodone and tramadol both increase sedation. Use Caution/Monitor.
- oxymorphone
oxymorphone and tramadol both increase sedation. Use Caution/Monitor.
- paliperidone
tramadol and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
papaveretum and tramadol both increase sedation. Use Caution/Monitor.
- papaverine
tramadol and papaverine both increase sedation. Use Caution/Monitor.
- paroxetine
paroxetine decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.
paroxetine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - peginterferon alfa 2b
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
tramadol decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.
- pentazocine
pentazocine and tramadol both increase sedation. Use Caution/Monitor.
pentazocine and tramadol both increase serotonin levels. Use Caution/Monitor. - pentobarbital
pentobarbital and tramadol both increase sedation. Use Caution/Monitor.
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 - perampanel
perampanel and tramadol both increase sedation. Use Caution/Monitor.
- perphenazine
tramadol and perphenazine both increase sedation. Use Caution/Monitor.
- phendimetrazine
tramadol increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and tramadol both increase sedation. Use Caution/Monitor.
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 - phentermine
tramadol increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
tramadol increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenytoin
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
tramadol and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
tramadol and pimozide both increase sedation. Use Caution/Monitor.
- pirbuterol
tramadol increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pregabalin
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
primidone and tramadol both increase sedation. Use Caution/Monitor.
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 - prochlorperazine
tramadol and prochlorperazine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and tramadol both increase sedation. Use Caution/Monitor.
- propafenone
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
propofol and tramadol both increase sedation. Use Caution/Monitor.
- propylhexedrine
tramadol increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
tramadol and protriptyline both increase sedation. Use Caution/Monitor.
protriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - quazepam
quazepam and tramadol both increase sedation. Use Caution/Monitor.
- quetiapine
tramadol and quetiapine both increase sedation. Use Caution/Monitor.
- quinacrine
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
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
tramadol and ramelteon both increase sedation. Use Caution/Monitor.
- remifentanil
tramadol, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.
- remimazolam
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.
- rifabutin
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
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
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
tramadol and risperidone both increase sedation. Use Caution/Monitor.
- ritonavir
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
rizatriptan and tramadol both increase serotonin levels. Use Caution/Monitor.
- rolapitant
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
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.
- salmeterol
tramadol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- SAMe
SAMe and tramadol both increase serotonin levels. Use Caution/Monitor.
- saquinavir
saquinavir will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- scullcap
tramadol and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and tramadol both increase sedation. Use Caution/Monitor.
- selegiline transdermal
selegiline transdermal and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- sertraline
sertraline decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.
sertraline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
sertraline decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite. - sevoflurane
sevoflurane and tramadol both increase sedation. Use Caution/Monitor.
- shepherd's purse
tramadol and shepherd's purse both increase sedation. Use Caution/Monitor.
- St John's Wort
St John's Wort and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- stiripentol
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.
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. - sufentanil
sufentanil and tramadol both increase sedation. Use Caution/Monitor.
- sumatriptan
sumatriptan and tramadol both increase serotonin levels. Use Caution/Monitor.
- sumatriptan intranasal
sumatriptan intranasal and tramadol both increase serotonin levels. Use Caution/Monitor.
- suvorexant
suvorexant and tramadol both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
- tapentadol
tapentadol and tramadol both increase sedation. Use Caution/Monitor.
tramadol and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely. - tazemetostat
tazemetostat will decrease the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tecovirimat
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.
- temazepam
temazepam and tramadol both increase sedation. Use Caution/Monitor.
- terbinafine
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
tramadol increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
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
tramadol and thiothixene both increase sedation. Use Caution/Monitor.
- tipranavir
tipranavir will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- topiramate
tramadol and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- trazodone
tramadol and trazodone both increase sedation. Use Caution/Monitor.
trazodone and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - triazolam
triazolam and tramadol both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and tramadol both increase sedation. Use Caution/Monitor.
- trifluoperazine
tramadol and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
tramadol and trimipramine both increase sedation. Use Caution/Monitor.
trimipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - triprolidine
triprolidine and tramadol both increase sedation. Use Caution/Monitor.
- venlafaxine
venlafaxine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- voriconazole
voriconazole will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- xylometazoline
tramadol increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
tramadol increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
tramadol and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
tramadol and ziprasidone both increase sedation. Use Caution/Monitor.
- zolmitriptan
zolmitriptan and tramadol both increase serotonin levels. Use Caution/Monitor.
- zotepine
tramadol and zotepine both increase sedation. Use Caution/Monitor.
Minor (19)
- acetazolamide
acetazolamide will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- asenapine
asenapine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- brimonidine
brimonidine increases effects of tramadol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- cyclophosphamide
cyclophosphamide will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- darifenacin
darifenacin will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- dextroamphetamine
dextroamphetamine increases effects of tramadol by unspecified interaction mechanism. Minor/Significance Unknown.
- dronedarone
dronedarone will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- eucalyptus
tramadol and eucalyptus both increase sedation. Minor/Significance Unknown.
- lidocaine
lidocaine increases toxicity of tramadol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- maraviroc
maraviroc will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- marijuana
marijuana will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- nilotinib
nilotinib will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- parecoxib
parecoxib will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- paroxetine
paroxetine decreases effects of tramadol by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of tramadol to active metabolite.
- ranolazine
ranolazine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- sage
tramadol and sage both increase sedation. Minor/Significance Unknown.
- tipranavir
tipranavir will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- ziconotide
ziconotide, tramadol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
Adverse Effects
>10%
Immediate release
- Constipation (24-46%)
- Nausea (24-40%)
- Dizziness/vertigo (26-33%)
- Headache (18-32%)
- Somnolence (16-25%)
- Vomiting (9-17%)
- CNS stimulation (7-14%)
- Dyspepsia (5-13%)
- Asthenia (6-12%)
- Pruritus (8-11%)
Extended release
- Nausea (5.7-25.1%)
- Headache (19-23.1%)
- Constipation (4.2-21.3%)
- Somnolence (4-16.1%)
- Dizziness (4.8-13.6%)
- Dry mouth (3.4-13.1%)
- Vomiting (1.9-10.4%)
1-10%
Immediate release
- Dry mouth (5-10%)
- Diarrhea (5-10%)
- Sweating (6-9%)
-
1 to <5%
- Malaise
- Vasodilation
- Anxiety
- Confusion
- Coordination disturbance
- Euphoria
- Miosis
- Nervousness
- Sleep disorder
- Abdominal pain
- Anorexia
- Flatulence
- Hypertonia
- Rash
- Visual disturbance
- Menopausal symptoms
- Urinary frequency
- Urinary retention
Extended release
- Asthenia (2.6-8.6%)
- Pruritus (1.9-7.3%)
- Anorexia (0.2-5.7%)
- Arthralgia 23 (5-5.4%)
- Sweating (0.6-5.3%)
- Insomnia (1.7-5%)
-
1 to <5%
- Cardiac disorders: Hypertension
- Gastrointestinal disorders: Dyspepsia, flatulence
- General disorders: Abdominal pain, accidental injury, chills, fever, flu syndrome, neck pain, pelvic pain
- Investigations: Hyperglycemia, urine abnormality
- Metabolism and nutrition disorders: Peripheral edema, weight loss
- Musculoskeletal, connective tissue and bone disorders: Myalgia
- Nervous system disorders: Paresthesia, tremor, withdrawal syndrome
- Psychiatric disorders: Agitation, anxiety, apathy, confusion, depersonalization, depression, euphoria, nervousness
- Respiratory, thoracic and mediastinal disorders: Bronchitis, pharyngitis, rhinitis, sinusitis
- Skin and subcutaneous tissue disorders: Rash
- Urogenital disorders: Prostatic disorder, urinary tract infection
- Vascular disorders: Vasodilatation
<1%
Immediate release
- Body as a whole: Accidental injury, allergic reaction, anaphylaxis, death, suicidal tendency, weight loss, Serotonin syndrome
- Cardiovascular: Orthostatic hypotension, syncope, tachycardia
- Central Nervous System: Abnormal gait, amnesia, cognitive dysfunction, depression, difficulty in concentration, hallucinations, paresthesia, seizure, tremor
- Respiratory: Dyspnea
- Skin: Stevens Johnson syndrome, toxic epidermal necrolysis, urticaria, vesicles
- Special senses: Dysgeusia
- Urogenital: Dysuria, menstrual disorder
Extended release
- Cardiac disorders: EKG abnormal, hypotension, tachycardia
- Gastrointestinal disorders: Gastroenteritis
- General disorders: Neck rigidity, viral infection
- Hematologic/Lymphatic disorders: Anemia, ecchymoses
- Metabolism and nutrition disorders: Blood urea nitrogen increased, GGT increased, gout, SGPT increased
- Musculoskeletal disorders: Arthritis, arthrosis, joint disorder, leg cramps
- Nervous system disorders: Emotional lability, hyperkinesia, hypertonia, thinking abnormal, twitching, vertigo
- Respiratory disorders: Pneumonia
- Skin and SC tissue disorders: Hair disorder, skin disorder, urticaria
- Special senses: Eye disorder, lacrimation disorder
- Urogenital disorders: Cystitis, dysuria, sexual function abnormality, urinary retention
Frequency Not Defined
- Cardiovascular: Abnormal ECG, hypertension, hypotension, myocardial ischemia, palpitations, pulmonary edema, pulmonary embolism
- Central nervous system: Migraine
- Gastrointestinal: Gastrointestinal bleeding, hepatitis, stomatitis, liver failure
- Laboratory abnormalities: Creatinine increase, elevated liver enzymes, hemoglobin decrease, proteinuria
- Sensory: Cataracts, deafness, tinnitus
Postmarketing Reports
Serotonin syndrome
Adrenal insufficiency
Androgen deficiency
QT prolongation/torsade de pointes
Mydriasis
Hypoglycemia
Nervous system disorders: Movement disorder, speech disorder
Psychiatric disorders: Delirium
Hyponatremia
Warnings
Black Box Warnings
Opioid analgesic risk evaluation and mitigation strategy (REMS)
- To ensure that benefits of opioid analgesics outweigh risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products; under requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers
- Consider using other tools to improve patient, household, and community safety, such as patient-prescriber agreements that reinforce patient-prescriber responsibilities
- To obtain further information on opioid analgesic REMS and for a list of accredited REMS CME/CE, call 1-800-503-0784, or log on to www.opioidanalgesicrems.com. FDA Blueprint can be found at www.fda.gov/OpioidAnalgesicREMSBlueprint
-
Healthcare providers are strongly encouraged to:
- Complete a REMS-compliant education program
- Counsel patients and/or their caregivers, with every prescription, on safe use, serious risks, storage, and disposal of these products
- Emphasize to patients and their caregivers the importance of reading the Medication Guide every time it is provided by their pharmacist
- Consider other tools to improve patient, household, and community safety
Addiction, abuse, and misuse
- Risk of opioid addiction, abuse, and misuse, which can lead to overdose and death; assess each patient’s risk prior to prescribing and monitor all patients regularly for the development of these behaviors or conditions
Life-threatening respiratory depression
- Serious, life-threatening, or fatal respiratory depression may occur
- Monitor for respiratory depression, especially during initiation or following a dose increase
Accidental ingestion
- Accidental ingestion of even 1 dose, especially by children, can result in a fatal overdose
Neonatal opioid withdrawal syndrome
- Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts
- If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available
Ultra-rapid metabolism and other risk factors for life-threatening respiratory depression in children
- Life-threatening respiratory depression reported in children who received tramadol; some reported cases occurred following tonsillectomy and/or adenoidectomy, and at least one case, the child had evidence of being an ultra-rapid metabolizer of tramadol due to a CYP2D6 polymorphism; therapy is contraindicated in children <12 years and in children <18 years of age following tonsillectomy and/or adenoidectomy; avoid use in adolescents 12-18 years who have other risk factors that may increase sensitivity to respiratory depressant effects
- Management of respiratory depression may include close observation, supportive measures, and use of opioid antagonists, depending on patient’s clinical status; carbon dioxide (CO2) retention from opioid-induced respiratory depression can exacerbate sedating effects of opioids
Interactions with drugs affecting Cytochrome P450 Isoenzymes
- Effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex.
- Use of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors requires careful consideration of the effects on the parent drug, tramadol, and the active metabolite, M1
Risks from concomitant use with benzodiazepines or other CNS depressants
- Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate; limit dosages and durations to minimum required; follow patients for signs and symptoms of respiratory depression and sedation
Contraindications
Hypersensitivity to tramadol or opioids
Known or suspected gastrointestinal obstruction, including paralytic ileus
Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within last 14 days
Children <12 years
Postoperative management in children <18 years following tonsillectomy and/or adenoidectomy
Severe/acute bronchial asthma in an unmonitored setting or in absence of resuscitative equipment
Significant respiratory depression
Cautions
Contains a Schedule IV controlled substance; exposes users to risks of addiction, abuse, and misuse; risks are increased in patients with a personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (eg, major depression); the potential for these risks should not, prevent proper management of pain in any given patient; patients at increased risk may be prescribed this medication, but use in such patients necessitates intensive counseling about risks and proper use along with intensive monitoring for signs of addiction, abuse, and misuse
Opioids are sought by drug abusers and people with addiction disorders and are subject to criminal diversion; consider these risks when prescribing or dispensing this medication; strategies to reduce risks include prescribing drug in smallest appropriate quantity and advising patient on proper disposal of unused drug; contact local state professional licensing board or state controlled substances authority for information on how to prevent and detect abuse or diversion of this product
Serotonin syndrome may occur; may be life-threatening; may occur with use of tramadol alone, with concomitant use of serotonergic drugs, with drugs that impair metabolism of serotonin or tramadol
Serious, life-threatening, or fatal respiratory depression has been reported; also occurred in children treated with tramadol
Opioids can cause sleep-related breathing disorders including central sleep apnea and sleep-related hypoxemia; opioid use increases risk of CSA in a dose-dependent fashion; in patients who present with CSA, consider decreasing opioid dosage using best practices for opioid taper
Prolonged use during pregnancy can result in withdrawal in the neonate
Seizures have been reported; spontaneous postmarketing reports indicate that seizure risk is increased with doses
May increase the risk of suicide
Cases of adrenal insufficiency have been reported with opioid use, more often following >1 month of use; if adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids
May cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients; monitor for signs of hypotension after initiating or titrating
May impair mental or physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery; advise not to drive or operate dangerous machinery unless tolerant to effects and aware of reaction to medication
Spasm of the sphincter of Oddi reported; opioids may cause increases in serum amylase; monitor with biliary tract disease, including acute pancreatitis for worsening symptoms
Serious and rarely fatal anaphylactic reactions have been reported
Cases of tramadol-associated hypoglycemia reported; some resulting in hospitalization; in most cases, patients had predisposing risk factors (eg, diabetes); if hypoglycemia suspected, monitor blood glucose levels and consider drug discontinuation as appropriate
Hyponatremia
- Hyponatremia reported, many cases severe; most cases occurred in females over 65 and within first week of therapy; in some reports, hyponatremia resulted from syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Monitor for signs and symptoms of hyponatremia (eg, confusion, disorientation), during treatment, especially during initiation of therapy; if signs and symptoms of hyponatremia are present, initiate appropriate treatment (eg, fluid restriction) and discontinue therapy
Patient access to naloxone for emergency treatment of opioid overdose
- Assess potential need for naloxone; consider prescribing for emergency treatment of opioid overdose
- Consult on availability and ways to obtain naloxone as permitted by individual state naloxone dispensing and prescribing requirements or guidelines
- Educate patients regarding the signs and symptoms of respiratory depression and to call 911 or seek immediate emergency medical help in the event of a known or suspected overdose
- Management of respiratory depression may include close observation, supportive measures, and use of opioid antagonists, depending on patient’s clinical status; carbon dioxide (CO2) retention from opioid-induced respiratory depression can exacerbate sedating effects of opioids
Drug interaction overview
- Substrate of CYP2B6, CYP2D6, CYP3A4
-
CYP2D6 Inhibitors
- Coadministration with CYP2D6 inhibitors (eg, amiodarone, quinidine) may result in increased tramadol plasma levels and decreased levels of the active metabolite, M1
- May result in signs and symptoms of opioid withdrawal and reduced efficacy; increased tramadol levels and toxicities including seizures and serotonin syndrome
-
CYP3A4 inhibitors or inducers
- Coadministration with CYP3A4 inhibitors or discontinuation CYP3A4 inducers may result in an increase in tramadol plasma concentrations and toxicities
- Coadministration of CYP3A4 inducers or discontinuation of CYP3A4 inhibitors may result in lower tramadol levels
-
CNS depressants
- Coadministration of opioids with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; if an opioid analgesic is initiated in a patient already taking a benzodiazepine or other CNS depressant, prescribe a lower initial dose of the opioid analgesic, and titrate based on clinical response; follow patients closely for signs and symptoms of respiratory depression and sedation; if concomitant use with benzodiazepine is warranted, consider prescribing naloxone for the emergency treatment of opioid overdose
- Due to risk of respiratory depression with concomitant use of skeletal muscle relaxants and opioids, consider prescribing naloxone for the emergency treatment of opioid overdose
-
Serotonergic drugs
- Coadministration with serotonergic drugs may increase the risk for serotonin syndrome
- Serotonergic drugs include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that affect the serotonergic neurotransmitter system (eg, mirtazapine, trazodone, tramadol), and drugs that impair metabolism of serotonin (including MAO-I)
-
Mixed agonist/antagonist and partial agonist opioid analgesics
- Avoid coadministration
- May reduce analgesic effect of tramadol or precipitate withdrawal symptoms
Pregnancy & Lactation
Pregnancy
Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome
Available data in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage; observe newborns for symptoms of neonatal opioid withdrawal syndrome and manage accordingly
Labor and delivery
- Use of tramadol during labor may lead to respiratory depression in the neonate
- Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates
- An opioid antagonist, such as naloxone, must be available for reversal of opioid-induced respiratory depression in the neonate
- Use is not recommended in pregnant women during or immediately prior to labor, when other analgesic techniques are more appropriate
- Opioid analgesics can prolong labor through actions which temporarily reduce the strength, duration, and frequency of uterine contractions
Lactation
Tramadol and its active metabolite, O-desmethyltramadol (M1), are present in human milk
Published studies and cases reported excessive sedation, respiratory depression, and death in infants exposed to codeine via breast milk
Women who are ultra-rapid metabolizers of tramadol achieve higher than expected serum levels of opioids, potentially leading to higher levels of M1 in breast milk that can be dangerous in their breastfed infants
In women with normal tramadol metabolism (normal CYP2D6 activity), the amount of tramadol secreted into human milk is low and dose-dependent
Owing to the potential for serious adverse reactions, including excess sedation, respiratory depression, and death in a breastfed infant, breastfeeding is not recommended during treatment
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Non-opioid-derived synthetic opioid; centrally acting analgesic, but may act at least partially by binding to opioid mu receptors, causing inhibition of ascending pain pathways
Absorption
Mean absolute bioavailability: ~75% (100-mg dose)
Steady-state of both tramadol and M1 are reached
- Immediate release: 2 days (QID dosing)
Peak plasma concentration
- Oral solution: 180.20 ng/mL (tramadol); 47.77 ng/mL (M1 metabolite)
- Immediate release: 173.51 ng/mL; 46.14 ng/mL (M1 metabolite)
- Extended release: 308 ng/mL (single 300-mg dose)
Peak plasma time
- Oral solution: 1.5 hr (tramadol); 2 hr (M1 metabolite)
- Immediate release: 1.5 hr (tramadol); 2.25 hr (M1 metabolite)
- Extended release: 10-12 hr (single-dose)
AUC
- Oral solution: 1623.93 ng·hr/mL (tramadol); 624.12 ng·hr/mL (M1 metabolite)
- Immediate release: 1681.64 ng·hr/mL ; 624.1 ng·hr/mL (M1 metabolite)
- Extended release: 6777 ng·hr/mL (single 300-mg dose)
Distribution
Protein bound: ~20% (IV)
Vd
- IV: 2.6L/kg (males); 2.9 L/kg (females)
Metabolism
Extensively metabolized via CYP2D6 and CYP3A4, as well as by conjugation of parent and metabolites
Elimination
Tramadol metabolites are eliminated primarily by kidneys
Excretion: ~30% (urine as unchanged drug); 60% as metabolites; remainder is excreted either as unidentified or as unextractable metabolites
Half-life
- Oral solution: 7.65 hr (tramadol); 7.94 hr (M1 metabolite)
- Immediate release: 7.61 hr (tramadol); 8.06 hr (M1 metabolite)
- Extended release: ~10 hr (tramadol); 11 hr (M1 metabolite)
Pharmacogenomics
Poor CYP2D6 metabolizers
- Formation of the active metabolite, M1, is mediated by CYP2D6, a polymorphic enzyme
- Based on a population PK analysis of Phase 1 studies with IR tablets in healthy subjects, tramadol concentrations were ~20% higher in "poor metabolizers" versus "extensive metabolizers," while M1 concentrations were 40% lower
Administration
Conversion from other opioids to extended release
Discontinue all other around-the-clock opioid drugs when initiating extended-release therapy
Initiate 100 mg PO qDay
No established conversion ratios for conversion from other opioids have been defined by clinical trials. Initiate
Conversion from oral solution to extended release
Bioavailability of oral solution compared to extended release tramadol is unknown
Closely monitor for signs of excessive sedation and respiratory depression when converting formulations
Oral Administration
Immediate release: Administer without regard to meals
Oral solution: Strongly advise to always use calibrated oral syringes or other oral dosing device, with metric units of measurements (ie, mL), to correctly measure prescribed dose
Extended release
- Swallow whole; do not crush, chew, dissolve, or split
- Administer without regard to meals
Storage
Store securely and dispose of properly
All formulations: Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)
Images
BRAND | FORM. | UNIT PRICE | PILL IMAGE |
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ConZip oral - | 100 mg capsule | ![]() | |
tramadol oral - | 300 mg tablet | ![]() | |
tramadol oral - | 200 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 200 mg tablet | ![]() | |
tramadol oral - | 100 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 100 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 100 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 300 mg tablet | ![]() | |
tramadol oral - | 200 mg tablet | ![]() | |
tramadol oral - | 100 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 300 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 50 mg tablet | ![]() | |
tramadol oral - | 100 mg capsule | ![]() |
Copyright © 2010 First DataBank, Inc.
Patient Handout
tramadol oral
TRAMADOL EXTENDED-RELEASE - ORAL
(TRAH-muh-dall)
COMMON BRAND NAME(S): ConZip, Ryzolt, Ultram ER
WARNING: Tramadol has a risk for abuse and addiction, which can lead to overdose and death. Tramadol may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of tramadol that works, and take it for the shortest possible time. See also How to Use section for more information about addiction.Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you take the wrong dose/strength. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death. Also, other medications can affect the removal of tramadol from your body, which may affect how tramadol works. Be sure you know how to take tramadol and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away.Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn't stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.Children younger than 12 years should not use products that contain tramadol. Children between 12 and 18 years old should not use tramadol after certain surgeries (including tonsil/adenoid removal). Also, tramadol use is not recommended for children between 12 and 18 years old who are obese or have breathing problems. Some children are more sensitive to tramadol and have had very serious (rarely fatal) breathing problems such as slow/shallow breathing (see also Side Effects section). Talk with your doctor or pharmacist about the risks and benefits of this medication.
USES: See also Warning section.This medication is used to help relieve severe ongoing pain. Tramadol belongs to a class of drugs known as opioid analgesics. It works in the brain to change how your body feels and responds to pain.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking tramadol and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication on a regular schedule as directed by your doctor, usually once daily (every 24 hours). If you have nausea, it may help to take this drug with food. Ask your doctor or pharmacist about other ways to decrease nausea (such as lying down for 1 to 2 hours with as little head movement as possible).Do not crush, chew, or dissolve extended-release tablets or capsules. Doing so can release all of the drug at once, increasing the risk of side effects or overdose. Swallow whole without crushing or chewing.The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Do not increase your dose, take the medication more frequently, or take it for a longer time than prescribed. Properly stop the medication when so directed.Before you start using this medication, ask your doctor or pharmacist if you should stop or change how you use your other opioid medication(s). Other pain relievers (such as acetaminophen, ibuprofen) may also be prescribed. Ask your doctor or pharmacist about using tramadol safely with other drugs.Suddenly stopping this medication may cause withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as restlessness, mental/mood changes (including anxiety, trouble sleeping, thoughts of suicide), watering eyes, runny nose, nausea, diarrhea, sweating, muscle aches, or sudden changes in behavior.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.Tell your doctor if your pain does not get better or if it gets worse.
SIDE EFFECTS: See also Warning section.Nausea, vomiting, constipation, sweating, trouble sleeping, dry mouth, fatigue, lightheadedness, dizziness, drowsiness, or headache may occur. Some of these side effects may decrease after you have been using this medication for a while. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: interrupted breathing during sleep (sleep apnea), mental/mood changes (such as agitation, hallucinations), severe stomach/abdominal pain, difficulty urinating, signs of your adrenal glands not working well (such as loss of appetite, unusual tiredness, weight loss).Get medical help right away if you have any very serious side effects, including: fast/irregular heartbeat, severe dizziness, fainting, seizure.This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.Tramadol is changed into a strong opioid drug in your body. In some people, this change happens faster and more completely than usual, which increases the risk of very serious side effects. Get medical help right away if you notice any of the following: slow/shallow breathing, severe drowsiness/difficulty waking up, confusion.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any of the following symptoms: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking tramadol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: brain disorders (such as head injury, tumor, seizures), breathing problems (such as asthma, sleep apnea, chronic obstructive pulmonary disease-COPD), kidney disease, liver disease, diabetes, mental/mood disorders (such as confusion, depression, suicidal thoughts), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), stomach/intestinal problems (such as blockage, constipation, diarrhea due to infection, paralytic ileus), difficulty urinating (such as due to enlarged prostate), gallbladder disease, disease of the pancreas (pancreatitis), obesity.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Tramadol may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using tramadol, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using tramadol safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Some children may be more sensitive to very serious side effects of tramadol, such as extreme sleepiness, confusion, or slow/shallow/noisy breathing. (See also Warning section.)Older adults may be more sensitive to the side effects of this drug, especially confusion, dizziness, drowsiness, slow/shallow breathing, and QT prolongation (see above). Older adults may also be more likely to develop a type of salt imbalance (hyponatremia) while using this drug.During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. (See also Warning section.)This medication passes into breast milk and may have undesirable effects on a nursing infant, such as unusual sleepiness, difficulty feeding, or trouble breathing. Breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also Warning section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: certain pain medications (mixed opioid agonist-antagonists such as butorphanol, nalbuphine, pentazocine), naltrexone, samidorphan.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Other medications can affect the removal of tramadol from your body, which may affect how tramadol works. Examples include azole antifungals (such as itraconazole), macrolide antibiotics (such as erythromycin), quinidine, rifamycins (such as rifampin), ritonavir, drugs used to treat seizures (such as carbamazepine), among others.The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as other opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.This medication may interfere with certain laboratory tests (including amylase/lipase levels), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, give them naloxone if available, then call 911. If the person is awake and has no symptoms, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow breathing, slow/irregular heartbeat, coma, seizure.
NOTES: Do not share this medication with others. Sharing it is against the law.This medication has been prescribed for your current condition only. Do not use it later for another condition unless told to do so by your doctor. A different medication may be necessary in that case.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from moisture. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised August 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.