Nutram Drug Interactions

Tramadol may increase the risk of seizures in patients taking SSRI, TCA, other tricyclic drugs (promethazine), and other opioids, MAO inhibitors, neuroleptics or other medications that lower the seizure threshold. Tramadol should not be given to patients receiving MAOI's or within 14 days of their discontinuation.
Concomitant use of tramadol and carbamazepine is not recommended.
Patients taking carbamazepine may have a significantly reduced analgesic effect or shorter duration of action of tramadol, because carbamazepine increases tramadol metabolism and reduces serum concentration. The risk of seizure is increased if tramadol is used with other drugs that have the potential to lower the seizure threshold.
Other drugs such as erythromycin and ketoconazole, might inhibit the metabolism of tramadol.
Metabolism of tramadol is mediated by the cytochrome P450 isoenzyme CYP2D6. Use with specific inhibitors of this enzyme, such as quinidine, may increase concentrations of tramadol and lower concentrations of its active metabolite but the clinical consequences of this effect are unclear.
The risk of paracetamol toxicity may be increased in patients receiving other potentially hepatotoxic drugs or drugs that induce liver microsomal enzymes. The absorption of paracetamol may be accelerated by drugs such as metoclopramide. Excretion may be affected and plasma concentrations altered when given with probenecid. Cholestyramine reduces the absorption of paracetamol if given within l hour of paracetamol.