MajorNatural opium alkaloids×Other opioids
Updated · Methodology
Mechanism
Additive CNS and respiratory centre depression. Tramadol is also serotonergic and lowers seizure threshold.
Symptoms
Drowsiness, slowed breathing (rate below 12/min), cyanosis of lips. Severe cases include respiratory arrest. Older patients: fall risk.
Management
Avoid the combination. To strengthen opioid analgesia on tramadol, switch to a pure opioid agonist (morphine, oxycodone) and stop tramadol. Dual opioid therapy is only used in palliative care with careful respiratory monitoring.
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