Use with MAO Inhibitors: The concomitant use of CATRAMOL with MAO Inhibitors or use within 14 days of their discontinuation, is contraindicated due to the increased risk of seizures and serotonin syndrome. Animal studies have shown increased deaths with combined administration of MAO inhibitors and Tramadol (see CONTRAINDICATIONS).
Use with Serotonin Reuptake Inhibitors: Concomitant use of Tramadol with SSRI's increases the risk of adverse reactions, including seizures and serotonin syndrome.
Use caution when administering CATRAMOL in patients taking SSRI's and monitor for signs of adverse reactions.
Central Nervous System (CNS) Depressants, including Alcohol: The concomitant use of Tramadol with central nervous system depressants such as Benzodiazepines and other sedatives/hypnotics, anesthetic agents, phenothiazines, tranquilizers, opioids or alcohol, may produce additive CNS depressant effects such as profound sedation and respiratory depression. If concomitant use of CATRAMOL with a CNS depressant is clinically necessary prescribe the lowest effective dosages and minimum duration for both drugs and follow patients closely for signs of respiratory depression.
Use with Carbamazepine: Concomitant administration of Tramadol hydrochloride and carbamazepine causes a significant increase in Tramadol metabolism. Patients taking carbamazepine may have a significantly reduced analgesic effect from the Tramadol component of CATRAMOL.
Use with Quinidine: Tramadol is metabolized to M1 by CYP12D6. Concomitant administration of quinidine and Tramadol results in increased concentrations of Tramadol. The clinical consequences of these findings are unknown.
Use with Warfarin Like Compounds: As medically appropriate, periodic evaluation of prothrombin time should be performed when CATRAMOL and warfarin like compounds are administered concurrently due to reports of increased INR in some patients.
Use with Inhibitor CYP2D6: In-vitro drug interaction studies in human liver microsomes indicated that concomitant administration with inhibitors of CYP2D6 such as fluoxetine, paroxetine, and amitriptyline could result in some inhibition of the metabolism of Tramadol.
Use with Cimetidine: Concomitant administration of CATRAMOL and Cimetidine has not been studied. Concomitant administration of Tramadol and Cimetidine does not result in clinically significant changes in Tramadol pharmacokinetics.