MAO Inhibitors and Serotonin Reuptake Inhibitors: Interaction with MAO inhibitors have been reported for some centrally acting drugs. (See Use with MAO Inhibitors and Serotonin Reuptake Inhibitors under Precautions).
Carbamazepine: Concomitant administration of tramadol HCl and carbamazepine causes a significant increase in tramadol metabolism. Patients taking carbamazepine may have a significantly reduced analgesic effect from the tramadol component of Ultracet.
Quinidine: Tramadol is metabolized to M1 by CYP2D6. Concomitant administration of quinidine and tramadol results in increased concentrations of tramadol. The clinical consequences of these findings are unknown.
Warfarin-Like Compounds: As medically appropriate, periodic evaluation of prothrombin time should be performed when Ultracet and these agents are administered concurrently due to reports of increased INR in some patients.
CYP2D6 Inhibitors: In vitro drug interaction studies in human liver microsomes indicate that concomitant administration with inhibitors of CYP2D6 eg, fluoxetine, paroxetine and amitriptyline could result in some inhibition of the metabolism of tramadol.
Cimetidine: Concomitant administration of Ultracet and cimetidine has not been studied. Concomitant administration of tramadol and cimetidine does not result in clinically significant changes in tramadol pharmacokinetics.