Belcetra Drug Interactions

Drug interactions: When this drug is used to patients who take selective serotonin re-uptake inhibitors (SSRIs)' tricyclic antidepressants (TCAs) and other tricyclic compounds (eq; promethazine) or other opioid, the risk of seizure may be increased. Tramadol may enhance the seizure risk in patients taking MAO inhibitor reducing the threshold of seizure, neuroleptic or other drugs. Caution should be exercised when this drug is administered to the patients who are receiving MAO inhibitor. In animal test, concurrent use of tramadol and MAO inhibitor enhanced the number of death. Concurrent use of tramadol with MAO inhibitor or selective serotonin re-uptake inhibitors may increase adverse reaction such as seizure or serotonin syndrome.
Patients taking carbamazepine may have a significantly reduced analgesic effect of tramadol. Because carbamazepine increases tramadol metabolism and because of the seizure risk associated with tramadol, concomitant administration of this drug and carbamazepine is not recommended.
Tramadol is metabolized to M1 by CYP2D6. Quinidine is a selective inhibitor of that isoenzyme; so that concomitant administration of quinidine and tramadol results in increased concentrations of tramadol and reduced concentrations of M1. The clinical consequences of these findings are unknown. In vitro drug interaction studies in human liver microsomes indicate that tramadol has no effect on quinidine metabolism, and concomitant administration with inhibitors of CYP2D6 such as fluoxetine, paroxetine, and amitriptyline could result in some inhibition of the metabolism of tramadol.
Other drugs known to inhibit CYP3A4, such as ketoconazole and erythromycin, might inhibit the metabolism of tramadol (N-demethylation) probably also the metabolism of the active O-demethylated metabolite. The clinical importance of such an interaction has not been studied.
The speed of absorption of paracetamol may be increased by metoclopramide or domperidone and absorption reduced by cholestyramine.