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The administration of Tramadol concurrently with CNS-depressant medicines is likely to intensify and prolong the CNS effects. Patients should be warned not to operate machinery or drive a car while using tramadol.
Seizures: Seizures have been reported in patients receiving Tramadol at dosages within the recommended dosage range. The risk of seizures is enhanced in patients exceeding the recommended dose, or in patients taking tricyclic anti-depressants or other tricyclic compounds e.g. Promethazine, selective serotonin re-uptake inhibitors and neuroleptics. The risk of seizures may also be increased in patients with epilepsy, with a history of seizures or in patients with a recognized risk for seizures e.g. Drug and alcohol withdrawal and intracranial infections, head trauma, metabolic disorders and naloxone treatment with tramadol overdose. Patients known to suffer from cerebral convulsions should be carefully monitored during treatment with tramadol.
Drug Abuse and Dependence: Although tramadol has a low dependence potential, tolerance, psychic and physical dependence of the morphine-type (μ opioid) may develop with long-term use. The drug has been associated with craving, drug-seeking behavior and tolerance development. Cases of abuse and dependence on tramadol have been reported. Tramadol should not be used in opioid-dependent patients. Tramadol can reinitiate physical dependence in patients with a tendency to drug abuse, a history of drug dependence or who are chronically using opioids, treatment with tramadol is not recommended.
Effects on ability to dive or operate machinery: Tramadol may affect reactions to the extent that driving ability and the ability to operate machinery may be impaired. This applies particularly in conjunction with other psychotropic medicines including alcohol.
