CriticalAnxiolytics. Benzodiazepine derivatives×Other opioids
Updated · Methodology
Mechanism
Tramadol is a weak opioid with additional serotonin–norepinephrine reuptake inhibition. With diazepam, the risk is doubled: additive CNS and respiratory depression plus a lowered seizure threshold (tramadol provokes seizures on its own).
Symptoms
Drowsiness, slowed breathing. Seizures may occur, especially in patients with prior epilepsy or with dose excess. Serotonin syndrome is less common unless other serotonergics are added.
Management
Avoid where possible. If unavoidable, minimal doses of both and a short course. Alternative analgesia: paracetamol with an NSAID; alternative anxiolytics: gabapentinoids or hydroxyzine.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Tramadol hydrochloride tablet (Amneal Pharmaceuticals NY LLC) – Prescribing Information (2017)– ; DailyMed setid 8ec4e4e5-a56e-4198-8428-6b770b9bf27d
- AEMPS: Ficha técnica: Tramadol (nº registro 63440), sección 4.4 (2024)– AEMPS, CIMA, nº registro 63440, revisión 09/2024, sección 4.4