Tramox Drug Interactions

Tramadol hydrochloride should not be administered to patients who are receiving MAO inhibitors or within 2 weeks of their withdrawal. Concomitant administration of Tramadol hydrochloride with other centrally acting drugs including alcohol may potentiate CNS depressant effects.
Tramadol may increase the potential for both selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) to cause convulsions (see Precautions and Pharmacology: Pharmacokinetics under Actions). There is a theoretical possibility that tramadol could interact with lithium. There have been no reports of this potential interaction.
Serotonergic drugs: Co-administration with serotonergic drugs, e.g. SSRIs or triptans, may lead to an increase of serotonin associated effects which can include serotonin syndrome.
There have been isolated reports of interaction with coumarin anticoagulants resulting in an increased INR and so care should be taken when commencing treatment with tramadol in patients on anticoagulants.
Pharmacokinetic studies were conducted to investigate the effects of cimetidine, quinidine and carbamazepine on the pharmacokinetics of tramadol.
Carbamazepine: Simultaneous administration of carbamazepine markedly decreases serum concentrations of tramadol to an extent that a decrease in analgesic effectiveness and a shorter duration of action may occur.
Cimetidine: With the concomitant or previous administration of cimetidine clinically relevant interactions are unlikely to occur. Therefore no alteration of the Tramadol hydrochloride dosage regimen is recommended for patients receiving chronic cimetidine therapy.
Quinidine: A study in 12 healthy volunteers has shown that quinidine causes an approximate 25% increase in the tramadol Cmax and AUC; Tmax is unaffected. However, the increases in Cmax and AUC fall within the normal therapeutic range for tramadol, and no dosage adjustment is required.
Benzodiazepines: Due to additive pharmacologic effect, the concomitant use of opioids with benzodiazepines increases the risk of respiratory depression, profound sedation, coma and death.
The concomitant use of opioids and benzodiazepines increases the risk of respiratory depression because of actions at different receptor sites in the central nervous system that control respiration. Opioids interact primarily at μ- receptors, and benzodiazepines interact at GABAA sites. When opioids and benzodiazepines are combined, the potential for benzodiazepines to significantly worsen opioid-related respiratory depression exists.
Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate (see Precautions).
Limit dosage and duration of concomitant use of benzodiazepines and opioids, and follow patients closely for respiratory depression and sedation.
Serotonergic Drugs: The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. Discontinue Tramox if serotonin syndrome is suspected. Examples of serotonergic drugs are selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that affect the serotonin neurotransmitter system (e.g. mirtazapine, trazodone, tramadol), monoamine oxidase (MAO) inhibitors (those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue) (see Precautions).