Tramadol Drug interactions that can affect the efficiency of the drug

Drug interactions change how the medications work or can result in severe side effects too. This article will help you discover some Tramadol drug interactions. Firstly, make a list of other medications that you are using currently apart from Tramadol. You can show this list to your doctor to know about various drug interactions. Your doctor can help you know about possible Tramadol interactions with the medications you are using currently.

Drugs that affect seizure threshold

Parallel use of Tramadol enhances the risk of seizures in patients taking SNRI/SSRI antidepressants or TCA antidepressants, anorectics and other tricyclic compounds, other opioids, neuroleptics or any other medications that reduce the seizure threshold.

CYP3A4 and/or CYP2D6 inhibitors

Tramadol is processed by CYP2D6 to build active metabolite- O-desmethyl tramadol (M1). The studies indicate that using CYP2D6 inhibitors like Amitriptyline, fluoxetine and paroxetine can lead to some obstruction in Tramadol metabolism process.

Tramadol is also processed by CYP3A4 and using CYP3A4 inhibitors like erythromycin, ketoconazole with Tramadol hydrochloride (extended release) can influence the process of tramadol metabolism resulting in changed tramadol exposure.


Based on mechanism of Tramadol and prospective of serotonin syndrome, extra caution should be taken when using Tramadol hydrochloride (extended release) with Triptans. The patient should be carefully monitored especially during the initial stages of treatment or dose increase.

Serotonergic drugs

The studies indicate the risk of serotonin syndrome in case of combined use of tramadol and SNRIs/SSRIs or a2-adrenergic blockers and MAOIs. Extra caution needs to be taken when tramadol hydrochloride (extended release) is taken with other drugs that can impact the serotonergic neurotransmitter system like MAOIs, triptans, SSRIs, lithium, linezolid, or St. John’s Wort. During the treatment when patient is treated with tramadol hydrochloride (extended release) and other medications that influence serotonergic neurotransmitter system, extra caution should be taken during initial stages of treatment and increment of dose.

CNS depressants

Tramadol hydrochloride (extended release) needs to be taken with extra caution and in low doses when given to the patients using CNS depressants like narcotics, anesthetic agents, opioids, sedative hypnotics, tranquilizers or phenothiazines. Tramadol hydrochloride (extended release) enhances the risk of respiratory and CNS depression in patients.

Warfarins and Digoxin

Some reports have indicated adjustment of warafin and digoxin toxicity effect including increase in prothrombin times.


Quinidine is a powerful inhibitor of CYP2D6. As per studies related to drug interactions, Tramadol doesn’t have any effect on metabolism of quinidine.

CYP3A4 Inducers

Patients using carbamazepine (CYP3A4 inducer) with Tramadol can have less analgesic effect of Tramadol as carbamazepine enhances metabolism of Tramadol and due to risk of seizures linked to tramadol, parallel use of tramadol hydrochloride(extended release)   and carbamazepine is not advised.

Do not take alcohol with tramadol and also let your doctor know if you are taking other medicines for allergy, cold, cough, anxiety, sleep, muscle relaxants, pain relievers (narcotic) psychiatric medicines etc., your doctor can help you know about the drug interactions and how to avoid them. He can recommend a dose change or other alternative medicines that can help you avoid risks associated with drug interactions.

Tramadol Dosage Information to get maximum benefit from the drug

This article will help you know about the right Tramadol dosage so that you can get maximum benefit from the drug. However, it is important to consult your doctor and follow doctor’s directions while using this drug.

Dosage Information- Tramadol Capsules

Things to consider for general dosing

Tramadol hydrochloride – extended release formulation is recommended for use once a day for adults aged 18 years and above. The capsule should be swallowed whole and should not be split, crushed, dissolved or chewed. Crushing, splitting or chewing the capsule can lead to unconstrained delivery of this medication, in death or overdose.

Patients not using Tramadol (immediate release) products currently

Start treatment with 100mg dose of Tramadol (extended release) to be taken once on a daily basis and dose can be adjusted as required by 100mg every 5 days to maintain a balance between tolerability and pain relief.

Patients using Tramadol (immediate release) products currently

Calculate the around the clock dose of tramadol IR and start a total dose of Tramadol  hydrochloride (extended-release) on a daily basis rounded down to lowest 100mg increase in the dose. The dose can be adjusted as per the needs of a particular patient.

Older patients – 65 years or above

Start with initial dose for an elderly patient above 65 years starting with the lowest dose as high doses can lead to decreased cardiac function renal function, concomitant disease, drug therapy or decreased hepatic. The administration of Tramadol Hydrochloride (extended release) should be carried out with extra caution in patients above 75 years due to adverse effects observed in this section.

Dosing information for patients – Renal Impairment

Due to limited availability of Tramadol Hydrochloride (extended release) dosing strength which is once on a daily basis, the medication is not recommended for safe use in patients suffering from serious renal impairment.

Hepatic Impairment

Due to limited availability of Tramadol Hydrochloride (extended release) dosing strength which is once on a daily basis, the medication is not recommended for safe use in patients suffering from serious hepatic impairment. Avoid using Tramadol Hydrochloride (extended release) in patients suffering from hepatic impairment.

Adult dose: For chronic pain

Extended release tablets

Initial dose: 100mg to be taken once in a day. Your doctor can increase the dose as required. However, the maximum dose should not exceed 300 mg per day.

Children: The dose and use is suggested by the doctor

Oral dosage – Tablets

Adults and youth – 16 years and above

Initial dose: 50-100 mg after every 4-6 hours as required. Your doctor can increase the dose as required. However, the maximum dose should not exceed 400 mg per day.

For Mild to Severe Pain

Oral dosage: disintegrating tablets

Adults and youth – 16 years and above

Initial dose: 50-100 mg after every 4-6 hours as required. Your doctor can increase the dose as required. However, the maximum dose should not exceed 400 mg per day.

Oral dosage – Tablets

Adults and youth – 16 years and above

Initial dose: 25 mg/per day to be taken every morning. Your doctor can increase the dose as required. However, the maximum dose should not exceed 400 mg per day.

Knowing about Tramadol in detail

Tramadol is a non narcotic pain reliever. It is normally used to treat mild to severe pain. The generic name of this medication is Tramadol and brand name is Ultram and Conzip. Tramadol is available in extended release form and this form is used as 24 hours treatment method for pain. This form of Tramadol cannot be used for as-needed purpose.

Some Important Information

Avoid taking Tramadol if you have consumed alcohol, tranquilizers, sedatives or narcotic medications couple of hours back. Tramadol can stop or slow breathing, especially whenever the dose is changed or you have started using the medication. Do not break, crush or open a (extended release) pill. Swallow it as whole to avoid fatal complications. Do not use Tramadol in high doses or take it for a prolonged period than prescribed.

Seizures were reported in some people using this medicine. Tramadol can cause seizures especially if you have a history of head injury, seizures, metabolic disorder or in case you are using some medications like muscle relaxers, antidepressants, narcotic drugs or medication for vomiting or nausea.

Tramadol can lead to drug dependency even during regular doses. Take these medications as suggested by your doctor. Do not share the medicine with any other person.

Avoid drinking alcohol as it can lead to harmful effects and even death when Tramadol is combined with alcohol. Tramadol should be taken orally. Do not take this medicine through injection or inhalation as it can result in life threatening side effects or overdose.

Do not take Tramadol if you are allergic to the medication or if you are suffering from

  1. a blockage in intestines or stomach
  2. breathing problems or severe asthma
  3. If you have used sedative, tranquilizers or narcotic drugs recently.

Speak to your doctor regarding seizure, which can increase if you have

  1. metabolic disorder
  2. history of alcohol addiction or drug addiction
  3. history of seizures, epilepsy or head injury
  4. if you are using other medicines to treat nausea, vomiting, mental illness, migraine headaches, muscles spasms etc.,

To know if Tramadol is suitable for you, tell your health care provider if you have

  1. stomach disorder
  2. kidney disease or liver disease
  3. History of mental illness, alcohol addiction, drug abuse or suicide attempt.

Tramadol can lead to breathing problems in elderly people who are malnourished, debilitated or suffer from severe illness.

Is Tramadol Addictive?

Most people think Tramadol is a narcotic like drug and there is no risk of addiction. The fact is that Tramadol can be addictive too because its highly effective for first six months and once an individual gets trapped in process of consuming more to achieve the same level of pain relief, they get addictive to the drug.

It is a misconception that Tramadol being a non narcotic medication is non addictive. Although in case of Tramadol the risk of addiction is quite lower as compared to other narcotic drugs. Again misuse of this drug or taking it in high doses has its own set of complications.

Is Tramadol recommended during pregnancy or breastfeeding?

Despite the fact that Tramadol is one of the strong analgesics having lower risk of physical and psychological dependence, there is still a concern of its use in pregnant women. Let us understand whether Tramadol is safe to use during pregnancy and breastfeeding.

Tramadol and Pregnancy

Pregnancy basically is a state of hormonal imbalances, which give birth to various symptoms like pain which can range from mild to severe pain. Most women experience migraine, headaches, backache, lower pelvic pain, and pain in lower limbs due to weight gain during pregnancy that builds up pressure on ligaments, muscles resulting in pain and edema.

Painkillers or Analgesics should be avoided during pregnancy as most painkillers can have impact on blood supplied to the baby by restricting the ability of umbilical vessels. The concern is rather huge when it comes to NSAIDs as NSAIDs constrict the main blood vessels. It can affect the supply of nutrition to the baby.

As per FDA Tramadol is not safe to be taken during pregnancy as it is categorized as a Class 3 drug.  Not enough evidences are available to weigh the level of side effects. In case the delivery date is nearing, Tramadol is not recommended as it can result in respiratory depression and foetus subsides.

Complications in Pregnancy due to Tramadol consumption

There are chances of building serious withdrawal symptoms, if mothers use tramadol for a prolonged period during pregnancy. The withdrawal symptoms occur within 24 to 48 hours of birth followed by trembling, wretched cry and respiratory changes.

To avoid complications in pregnancy avoid using Tramadol and if other medications aren’t effective to treat pain, try to use tramadol in smaller dosage as Tramadol intersects the placenta. Make sure the dosage doesn’t exceed 50-100mg per day.

Tramadol and Breastfeeding

Most health care providers recommend use of painkillers to mothers after birth of their child to treat pain in case muscular pain occurs after delivery, caesarean section, and episiotomy. Tramadol is preferred by many people because of its strong analgesic effect. But like any other drugs, Tramadol too gets transferred in breast milk and some quantity enters baby’s body if it is used by nursing mothers for a long period.

There are unwanted side effects seen in babies like drug dependency, toxicity, immature hepatic or renal system, which is not strong enough to flush out drug metabolites out of the body and it results in accumulation of drugs in the body.

Babies tend to get withdrawal symptoms once the mother stops using tramadol suddenly. Babies tend to develop drug dependency faster than adults. Mothers should avoid using Tramadol during breast feeding or take low doses when required instead of taking high doses or taking it for a long period.

Monitor your baby for any health ailments and if you notice any unusual symptoms contact your paediatrician immediately. You should not take Tramadol on a regular basis and try to use some other alternative medicines for pain relief. This way you can avoid the risks associated with Tramadol during breastfeeding.

Common and Major side effects of Tramadol

Tramadol is a powerful drug having mild to severe side effects, which is a matter of concern for both patients and clinicians. Some side effects can be treated by changing the dose and some go away with time as your body gets used to the medicine. But, there are some major side effects that need immediate medical help else they can be life threatening.

Major- Less Common side effects

  • bloating
  • blurred vision
  • blood in urine
  • decreased or abnormal touch sensation
  • stomach or abdominal fullness
  • chills
  • change in balance and walking
  • fainting
  • difficult urination
  • darkened urine
  • fast heartbeat
  • convulsions
  • increased heart rate
  • memory loss
  • indigestion
  • tingling and numbness of toes, face, fingers
  • Discomfort or pain in lower back, legs, and arms especially pain in heels or carves upon exertion.
  • recurrent fever
  • severe cramping
  • sweats
  • itching, swelling, redness of skin
  • shaking or trembling of feet or hands
  • yellow skin or eyes
  • problems in carrying out routine tasks
  • severe nausea
  • breathlessness
  • Feeling, seeing, hearing things that doesn’t exist.

Symptoms of overdose

  • breathing problems
  • decreased responsiveness or awareness
  • light-headedness
  • severe sleepiness
  • pinpointed eye pupils
  • unusual tiredness
  • breathlessness
  • irregular or slow heartbeat

Minor side effects

If you notice minor side effects, they basically do not need medical attention as they disappear with time. As your body gets used to the medication, these minor side effects vanish. But if they exist for long, get in touch with your doctor immediately.

More Common

  • agitation
  • anxiety
  • diarrhoea
  • drowsiness
  • constipation
  • drowsiness
  • discouragement
  • headache
  • fever
  • heartburn
  • feeling empty or sad
  • joint pain
  • itching skin
  • irritability
  • nausea
  • muscle pains or aches
  • loss of strength
  • appetite loss
  • loss of pleasure or interest
  • runny nose
  • restlessness
  • sore throat
  • shivering
  • problems in concentrating
  • weakness
  • tiredness
  • stuffy nose


  • scaly or cracked skin
  • bladder pain
  • back pain
  • abnormal dreams
  • decreased appetite
  • confusion
  • ear congestion
  • earache/pain in ear
  • ear drainage
  • excessive gas
  • pain, difficult or burning urination
  • feeling hot
  • fall
  • unusual or false sense of well-being
  • feeling jittery
  • Goosebumps
  • hot flashes
  • hoarseness
  • joint swelling
  • joint sprain
  • joint stiffness
  • voice loss
  • muscle injury
  • muscle twitching
  • neck pain
  • pain
  • nasal congestion
  • skin discoloration
  • chest tightness
  • breathing problems
  • sleeping problems

Some side effects can occur after treatment, when you stop using this drug; there is a possibility that you notice side effects that need medical help. In such cases contact your physician immediately

  1. trembling or shivering
  2. gooseflesh
  3. large pupils
  4. high BP
  5. increased sweating
  6. increased yawning
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