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Tramadol Hydrochloride

Also known as: Tramadol Hydrochloride

Route: Oral

Check Tramadol Hydrochloride Interactions →

14 interactions on record⛔ Black Box Warning

Tramadol Hydrochloride has 14 known drug interactions based on U.S. FDA drug labeling data. Of these, 1 are contraindicated combinations that should be avoided entirely. 11 are classified as major interactions requiring close medical supervision. Notable interactions include combinations with Carbamazepine, Amitriptyline, Bupropion. Patients taking Tramadol Hydrochloride should inform their healthcare provider of all current medications — including over-the-counter drugs and supplements — to avoid potentially harmful combinations. Data sourced from OpenFDA and the NIH National Library of Medicine.

Total: 14
Contraindicated: 1
Major: 11
Moderate: 2

Contraindicated (1)

Tramadol Hydrochloride + Carbamazepine— CYP3A4 inducer that significantly reduces tramadol analgesic effect and increases seizure risk. Concomitant use is not r…

Major (11)

Tramadol Hydrochloride + Amitriptyline— CYP2D6 inhibitor that increases tramadol concentrations and decreases M1 concentrations, increasing risk for serious adv…
Tramadol Hydrochloride + Bupropion— CYP2D6 inhibitor may increase tramadol plasma concentration and decrease M1 concentration, resulting in increased risk o…
Tramadol Hydrochloride + Erythromycin— Administration of CYP3A4 inhibitors, such as ketoconazole and erythromycin, or inducers, such as rifampin and St. Drug I…
Tramadol Hydrochloride + Fluoxetine— CYP2D6 inhibitor may increase tramadol plasma concentration and decrease M1 concentration, resulting in increased risk o…
Tramadol Hydrochloride + Ketoconazole— ketoconazole), protease inhibitors (e.g., ritonavir) CYP3A4 Inducers Clinical Impact: The concomitant use of tramadol hy…
Tramadol Hydrochloride + Macrolide Antibiotics— CYP3A4 inhibitors that increase tramadol plasma concentration and M1 levels, increasing risk of seizures, serotonin synd…
Tramadol Hydrochloride + Mao Inhibitors— Increase tramadol plasma concentration and may increase M1 levels via CYP2D6, risking seizures, serotonin syndrome, opio…
Tramadol Hydrochloride + Paroxetine— CYP2D6 inhibitor may increase tramadol plasma concentration and decrease M1 concentration, resulting in increased risk o…
Tramadol Hydrochloride + Protriptyline Hydrochloride— Protriptyline may enhance seizure risk in patients taking tramadol hydrochloride.
Tramadol Hydrochloride + Quinidine— CYP2D6 inhibitor may increase tramadol plasma concentration and decrease M1 concentration, resulting in increased risk o…
Tramadol Hydrochloride + Ritonavir— ketoconazole), protease inhibitors (e.g., ritonavir) CYP3A4 Inducers Clinical Impact: The concomitant use of tramadol hy…

Moderate (2)

Tramadol Hydrochloride + Rifampin— CYP3A4 inducer that may alter tramadol metabolism and exposure.
Tramadol Hydrochloride + St. John'S Wort— CYP3A4 inducer that may alter tramadol metabolism and exposure.

Tramadol Hydrochloride + Carbamazepine⛔Contraindicated

CYP3A4 inducer that significantly reduces tramadol analgesic effect and increases seizure risk. Concomitant use is not recommended.

Tramadol Hydrochloride + Amitriptyline⚠️Major

CYP2D6 inhibitor that increases tramadol concentrations and decreases M1 concentrations, increasing risk for serious adverse events including seizures and serotonin syndrome.

Tramadol Hydrochloride + Bupropion⚠️Major

CYP2D6 inhibitor may increase tramadol plasma concentration and decrease M1 concentration, resulting in increased risk of seizures, serotonin syndrome, and opioid withdrawal or toxicity.

Tramadol Hydrochloride + Erythromycin⚠️Major

Administration of CYP3A4 inhibitors, such as ketoconazole and erythromycin, or inducers, such as rifampin and St. Drug Interactions CYP2D6 and CYP3A4 inhibitors: Concomitant administration of CYP2D6 and/or CYP3A4 inhibitors (See CLINICAL PHARMACOLOGY—Pharmacokinetics ), such as quinidine, fluoxetine, paroxetine and amitriptyline (CYP2D6 inhibitors), and ketoconazole and erythromycin (CYP3A4 inhibitors), may reduce metabolic clearance of tramadol increasing the risk for serious adverse events including seizures and serotonin syndrome. Administration of CYP3A4 inhibitors, such as ketoconazole and erythromycin, or inducers, such as rifampin and St.

Tramadol Hydrochloride + Fluoxetine⚠️Major

CYP2D6 inhibitor may increase tramadol plasma concentration and decrease M1 concentration, resulting in increased risk of seizures, serotonin syndrome, and opioid withdrawal or toxicity.

Tramadol Hydrochloride + Ketoconazole⚠️Major

ketoconazole), protease inhibitors (e.g., ritonavir) CYP3A4 Inducers Clinical Impact: The concomitant use of tramadol hydrochloride tablets and CYP3A4 inducers can decrease the plasma concentration of tramadol[see Clinical Pharmacology (12.3)], resulting in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence to tramadol.After stopping a CYP3A4 inducer, as the effects of the inducer decline, the tramadol plasma concentration will increase[see Clinical Pharmacology (12.3)], which could increase or prolong both the therapeutic effects and adverse reactions, and may cause seizures, serotonin syndrome, and/or potentially fatal respiratory depression.

Tramadol Hydrochloride + Macrolide Antibiotics⚠️Major

CYP3A4 inhibitors that increase tramadol plasma concentration and M1 levels, increasing risk of seizures, serotonin syndrome, and potentially fatal respiratory depression.

Tramadol Hydrochloride + Mao Inhibitors⚠️Major

Increase tramadol plasma concentration and may increase M1 levels via CYP2D6, risking seizures, serotonin syndrome, opioid toxicity, and potentially fatal respiratory depression.

Tramadol Hydrochloride + Paroxetine⚠️Major

CYP2D6 inhibitor may increase tramadol plasma concentration and decrease M1 concentration, resulting in increased risk of seizures, serotonin syndrome, and opioid withdrawal or toxicity.

Tramadol Hydrochloride + Protriptyline Hydrochloride⚠️Major

Protriptyline may enhance seizure risk in patients taking tramadol hydrochloride.

Tramadol Hydrochloride + Quinidine⚠️Major

CYP2D6 inhibitor may increase tramadol plasma concentration and decrease M1 concentration, resulting in increased risk of seizures, serotonin syndrome, and opioid withdrawal or toxicity.

Tramadol Hydrochloride + Ritonavir⚠️Major

Tramadol Hydrochloride + Rifampin🟡Moderate

CYP3A4 inducer that may alter tramadol metabolism and exposure.

Tramadol Hydrochloride + St. John'S Wort🟡Moderate

CYP3A4 inducer that may alter tramadol metabolism and exposure.

Data sourced from U.S. FDA drug labeling via openFDA and the NIH National Library of Medicine. For informational purposes only. Always consult your pharmacist or physician.