|
| Drugs | Drugs interaction/AEs | Actions/comments |
|
| Anticoagulants | Observed PT and INR increased.
Reported extensive ecchymoses. | INR monitoring, caution is recommended. |
|
| Antifungals | Increased risk of seizures, serotonin syndrome. | Ketoconazole decreased tramadol clearance. |
|
| Carbamazepine | Risk of tramadol-associated seizures. | Concomitant use is not recommended.
Increased metabolism of tramadol resulting in decreasing analgesic effect. |
|
| Cimetidine | Tramadol pharmacokinetics not altered. | |
|
| CNS depressants (alcohol, anesthetics, phenothiazines, sedatives, hypnotics, and opiates) | Risk of respiratory depression, CNS depression effects. Risk of fatal overdosage. | Caution is recommended; monitor patient closely, during treatment; use reduced dosage. |
|
| Digoxin | Rare episodes of digoxin toxicity are reported. | Caution is recommended; monitor patient closely, during treatment initiation and dosage escalation. |
|
| Linezolid | Increased risk of serotonin syndrome. | Caution is recommended; monitor patient closely, during treatment initiation and dosage escalation. |
|
| Lithium | Increased risk of serotonin syndrome. | Caution is recommended; monitor patient closely, during treatment initiation and dosage escalation. |
|
| Macrolides | Increased risk of seizures, serotonin syndrome. | Caution is recommended.
Erythromycin decreased tramadol clearance. |
|
| MAO inhibitors | Increasing risk of seizures, serotonin syndrome. | Extreme caution is recommended. |
|
| Quinidine | Increased risk of seizures, serotonin syndrome. | Caution is recommended. Increased tramadol and decreases M1 concentrations. |
|
| Rifampin | Increased risk of seizures, serotonin syndrome. | Caution is recommended. |
|
| SNRIs | Increased risk of seizures, serotonin syndrome. | Caution is recommended; monitor patient closely, during treatment initiation and dosage escalation. |
|
| SSRIs | Increased risk of serotonin syndrome, seizures. | Caution is recommended monitor patient closely, during treatment initiation and dosage escalation.
Fluoxetine and paroxetine (CYP2D6 inhibitors) may inhibit tramadol metabolism, with increasing tramadol and decreasing M1 concentrations. |
|
| Hypericum perforatum | Increased risk of serotonin syndrome, seizures. | Caution is recommended; monitor patient closely, during treatment initiation and dosage escalation. |
|
| Tricyclics | Increased risk of seizures, serotonin syndrome. | Caution is recommended monitor patient closely, during treatment initiation and dosage escalation. Amitriptyline may inhibit tramadol metabolism, with increasing tramadol and decreasing M1 concentrations. |
|
| Triptans | Increased risk of seizures, serotonin syndrome. | Caution is recommended; monitor patient closely, during treatment initiation and dosage escalation. |
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