Basic Information
ID DDInter1841 and DDInter429
Interaction Concomitant use of tramadol with other central nervous system (CNS) depressants including other opioids may result in profound sedation, respiratory depression, coma, and death. The risk of hypotension and seizures may also be increased. In patients who have been previously dependent on or chronically using opioids, tramadol can reinitiate physical dependence or precipitate withdrawal symptoms.
Management Concomitant use of tramadol with other opioids should generally be avoided. If coadministration is necessary, the dosage and duration of each drug should be limited to the minimum required to achieve desired clinical effect. Patients should be monitored closely for development of seizures, respiratory depression and sedation, and advised to avoid driving or operating hazardous machinery until they know how these medications affect them. Cough medications containing opioids (e.g., codeine, hydrocodone) should not be prescribed to patients on tramadol. In addition, tramadol should not be used in opioid-dependent patients, and use in patients who are chronically on opioids is also not recommended. Tramadol is contraindicated in patients with acute opioid intoxication.
References [1] "Product Information. Ultram (tramadol)." McNeil Pharmaceutical, Raritan, NJ. [2] "Product Information. Zohydro ER (HYDROcodone)." Zogenix, Inc, San Diego, CA. [3] "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ. [4] Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press Inc. (1990): [5] Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7 [6] "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc, Rockville, MD.
Alternative for Tramadol N02A
Acetaminophen Acetylsalicylic acid Codeine Ibuprofen
Alternative for Codeine N02A
Tramadol

R05D
Benzonatate
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.