Moderate
Theophylline × Tramadol
Methylxanthine×Other opioids
Mechanism
Both lower the seizure threshold. Additive risk, especially in theophylline overdose or in patients with epilepsy and prior head trauma.
Symptoms
Tremor, jitters, anxiety; severe cases: seizures. Symptoms appear with theophylline or tramadol dose escalation.
Management
Avoid the combination in epilepsy or prior head trauma. At usual therapeutic theophylline doses and short tramadol courses (3–5 days), the combination is acceptable in young patients. Keep theophylline levels in the lower half of normal range (10–15 mcg/mL). Analgesic alternatives: paracetamol with codeine, or gabapentin for neuropathic pain.
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.