4 known interactions • 3 major • 1 moderate • 0 minor
Always disclose all medications to your healthcare providers — prescription medicines, OTC medications, vitamins, and herbal supplements. This list may not include every possible interaction. Use our Medicine Interaction Checker to screen your complete medication list.
Potentially life-threatening or causing permanent damage. Avoid combination.
May worsen condition or require dose adjustment. Monitor closely.
Usually limited clinical effect. Manage with routine monitoring.
MAOIs
Risk of serotonin syndrome and seizures. Contraindicated.
Management: Absolutely contraindicated. 14-day washout from MAOI required before tramadol.
SSRIs / SNRIs (sertraline, fluoxetine, duloxetine)
Serotonin syndrome risk from additive serotonergic effects. Additionally, fluoxetine/paroxetine inhibit CYP2D6, reducing tramadol conversion to active M1 metabolite (reducing efficacy) while potentially increasing tramadol-related serotonergic toxicity.
Management: Monitor closely for serotonin syndrome (agitation, hyperthermia, clonus, diaphoresis). Consider alternative analgesic.
CNS depressants (benzodiazepines, opioids, alcohol, muscle relaxants)
Additive CNS and respiratory depression. Risk of fatal respiratory depression.
Management: Avoid combination when possible. FDA requires opioid/benzodiazepine co-prescribing warning on labels.
Carbamazepine
Induces CYP3A4, significantly increasing tramadol metabolism and reducing efficacy. Also both agents lower seizure threshold.
Management: Consider alternative analgesic; if combination necessary, higher tramadol dose may be needed with careful monitoring.
Always ask your pharmacist about potential interactions with food, alcohol, and supplements specific to Tramadol. Some medicines have significant interactions with grapefruit juice, high-fat meals, dairy products, or vitamin K-rich foods.