Tramadol drug interactions: Difference between revisions
m Reverted edits by PodpolezaFdc (talk) to last revision by Lakshmi Gopalakrishnan |
No edit summary |
||
| Line 26: | Line 26: | ||
Patients taking carbamazepine may have a significantly reduced analgesic effect of tramadol. Because | Patients taking carbamazepine may have a significantly reduced analgesic effect of tramadol. Because | ||
carbamazepine increases tramadol metabolism and because of the seizure risk associated with tramadol | carbamazepine increases tramadol metabolism and because of the seizure risk associated with tramadol | ||
concomitant administration of | concomitant administration of ULTRACET and carbamazepine is not recommended. | ||
===Use with Quinidine=== | ===Use with Quinidine=== | ||
| Line 33: | Line 33: | ||
tramadol and reduced concentrations of M1. The clinical consequences of these findings are unknown. | tramadol and reduced concentrations of M1. The clinical consequences of these findings are unknown. | ||
In vitro drug interaction studies in human liver microsomes indicate that tramadol has no effect on | In vitro drug interaction studies in human liver microsomes indicate that tramadol has no effect on | ||
quinidine metabolism. | quinidine metabolism. | ||
===Use with Inhibitors of CYP2D6=== | ===Use with Inhibitors of CYP2D6=== | ||
In vitro drug interaction studies in human liver microsomes indicate that concomitant administration | In vitro drug interaction studies in human liver microsomes indicate that concomitant administration | ||
with inhibitors of CYP2D6 such as fluoxetine, paroxetine, and amitriptyline could result in some | with inhibitors of CYP2D6 such as fluoxetine, paroxetine, and amitriptyline could result in some | ||
inhibition of the metabolism of tramadol. | inhibition of the metabolism of tramadol. | ||
===Use with Cimetidine=== | ===Use with Cimetidine=== | ||
Concomitant administration of | 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 | administration of tramadol and cimetidine does not result in clinically significant changes in tramadol | ||
pharmacokinetics. Therefore, no alteration of the | pharmacokinetics. Therefore, no alteration of the ULTRACET dosage regimen is recommended. | ||
===Use with MAO Inhibitors=== | ===Use with MAO Inhibitors=== | ||
Interactions with MAO Inhibitors, due to interference with detoxification mechanisms, have been | Interactions with MAO Inhibitors, due to interference with detoxification mechanisms, have been | ||
reported for some centrally acting drugs. | reported for some centrally acting drugs. | ||
===Use with Digoxin=== | ===Use with Digoxin=== | ||
Post-marketing surveillance of tramadol has revealed rare reports of digoxin toxicity. | Post-marketing surveillance of tramadol has revealed rare reports of digoxin toxicity. | ||
===Use with Warfarin Like Compounds=== | ===Use with Warfarin Like Compounds=== | ||
| Line 56: | Line 56: | ||
alterations of warfarin effect, including elevation of prothrombin times. | alterations of warfarin effect, including elevation of prothrombin times. | ||
While such changes have been generally of limited clinical significance for the individual products, | While such changes have been generally of limited clinical significance for the individual products, | ||
periodic evaluation of prothrombin time should be performed when | periodic evaluation of prothrombin time should be performed when ULTRACET and warfarin-like | ||
compounds are administered concurrently. | compounds are administered concurrently. | ||
<br> | <br> | ||
<br> | <br> | ||
Revision as of 15:45, 18 December 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
List of drug interactions
Use with Carbamazepine
Use with Quinidine
Use with Inhibitors of CYP2D6
Use with Cimetidine
Use with MAO Inhibitors
Use with Digoxin
Use with Warfarin Like Compounds
Use with Carbamazepine
Patients taking carbamazepine may have a significantly reduced analgesic effect of tramadol. Because carbamazepine increases tramadol metabolism and because of the seizure risk associated with tramadol concomitant administration of ULTRACET and carbamazepine is not recommended.
Use with Quinidine
Tramadol is metabolized to M1 by CYP2D6. Quinidine is a selective inhibitor of that isoenzyme; so that concomitant administration of quinidine and tramadol results in increased concentrations of tramadol and reduced concentrations of M1. The clinical consequences of these findings are unknown. In vitro drug interaction studies in human liver microsomes indicate that tramadol has no effect on quinidine metabolism.
Use with Inhibitors of CYP2D6
In vitro drug interaction studies in human liver microsomes indicate 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 ULTRACET and cimetidine has not been studied. Concomitant administration of tramadol and cimetidine does not result in clinically significant changes in tramadol pharmacokinetics. Therefore, no alteration of the ULTRACET dosage regimen is recommended.
Use with MAO Inhibitors
Interactions with MAO Inhibitors, due to interference with detoxification mechanisms, have been reported for some centrally acting drugs.
Use with Digoxin
Post-marketing surveillance of tramadol has revealed rare reports of digoxin toxicity.
Use with Warfarin Like Compounds
Post-marketing surveillance of both tramadol and acetaminophen individual products have revealed rare
alterations of warfarin effect, including elevation of prothrombin times.
While such changes have been generally of limited clinical significance for the individual products,
periodic evaluation of prothrombin time should be performed when ULTRACET and warfarin-like
compounds are administered concurrently.
Adapted from the FDA Package Insert.