Tramadol Interactions: What You Should Know

Tramadol is a powerful painkiller used to treat moderate and severe pain. While it can be highly effective, tramadol can interact with other medications in dangerous ways – mixing tramadol with the wrong drugs can lead to serious side effects, like trouble breathing, extreme drowsiness, or even life-threatening conditions.

This guide explores these drug interactions to help keep you safe while getting the pain relief you need. You will also learn how to get effective and compassionate treatment for prescription drug addiction.

What Is Tramadol?

Tramadol is a prescription medication doctors use to help people manage moderate and severe pain. It’s an opioid agonist that changes how the brain responds to pain. When you take tramadol, it helps reduce the feeling of pain by mimicking natural chemicals in the brain called endorphins. Endorphins bind to receptors in the brain, helping block pain signals.

Tramadol comes in different forms, such as tablets or capsules, and can be taken as an immediate-release or extended-release medication. Immediate-release tramadol works quickly, providing fast relief, while extended-release tramadol is designed to release slowly over time, helping with pain control throughout the day. Doctors usually prescribe it for short-term use, but in some cases, it may be used to manage chronic pain.

While tramadol is effective for pain relief, it’s also a controlled substance because it carries a risk of misuse, addiction, and dependence. This means you should only take it as directed to avoid serious complications.

What Should You Not Take With Tramadol

Tramadol is a strong painkiller, and when combined with certain other medications or substances, it can cause dangerous side effects. Some combinations can lead to severe drowsiness, trouble breathing, or even death. Here are some of the most important things you should not take with tramadol:

• Benzodiazepines: Benzodiazepines like Xanax, Valium, or Klonopin are drugs used to treat anxiety, seizures, and sleep disorders. Combining tramadol with benzodiazepines can cause tiredness, slow breathing, and increase the risk of overdose because both medications affect the CNS (central nervous system) – the CNS controls breathing and heart rate.
• Other opioids: Mixing tramadol with other opioid painkillers like oxycodone, hydrocodone, or morphine is dangerous. Both drugs slow the CNS, which can lead to respiratory failure, coma, or death. If you’re already using opioids, consult your doctor before taking tramadol.
• Alcohol: Alcohol and tramadol are a dangerous combination. Drinking alcohol while taking tramadol can increase the risk of serious side effects like extreme drowsiness, dizziness, and slowed breathing. In severe cases, this can lead to overdose and death. Avoid alcohol completely while using tramadol.
• Antidepressants: Certain antidepressants – particularly those in the SSRI (selective serotonin reuptake inhibitor) class like Lexapro or Prozac – can interact with tramadol. This can cause a condition called serotonin syndrome, where too much serotonin builds up in the brain. Symptoms include high blood pressure, rapid heart rate, confusion, tremors, sweating, and seizures. This is a medical emergency and requires immediate treatment.
• MAOIs: MAOI (monoamine oxidase inhibitors) antidepressants like phenelzine or selegiline are medications used to treat depression. Taking these drugs with tramadol can increase the risk of serious side effects, like serotonin syndrome or severe high blood pressure. It’s recommended to stop taking MAOIs at least two weeks before starting tramadol.
• Seizure medications: Tramadol can lower the seizure threshold, meaning it makes you more likely to have a seizure. If you’re taking medications like Depakote or Lamictal for seizures or other neurological conditions, combining them with tramadol could increase your risk of having a seizure. Always consult your doctor before taking tramadol if you’re on seizure medication.
• Muscle relaxants: Muscle relaxants like Flexeril or Soma help relieve muscle spasms but can also cause drowsiness and slow your breathing. When combined with tramadol, these effects can intensify, leading to extreme drowsiness, slowed breathing, and an increased risk of overdose. Avoid combining these drugs unless directed by your doctor.
• Antihistamines (like Benadryl): Antihistamines – especially those that cause drowsiness like Benadryl – should be avoided when taking tramadol. Combining these medications can lead to excessive drowsiness, dizziness, and slowed breathing. Some over-the-counter sleep aids also contain antihistamines, so check the labels carefully.
• Blood thinners (like Warfarin): Taking tramadol with blood thinners like Warfarin can increase the risk of bleeding complications. Warfarin is used to prevent blood clots, and tramadol may interfere with how Warfarin works in your body. This could cause excessive bruising, bleeding gums, or more serious bleeding problems. If you’re taking blood thinners, your doctor may want to monitor your blood clotting levels closely while you’re on tramadol.
• Anti-anxiety medications: Medications like buspirone and hydroxyzine, used to treat anxiety, can also interact with tramadol. These drugs, like muscle relaxants and benzodiazepines, can increase drowsiness and slow breathing when taken with tramadol, leading to dangerous side effects.
• St. John’s Wort: St. John’s Wort is a supplement commonly used for depression. It can increase the levels of serotonin in the brain when taken with tramadol, increasing the chance of serotonin syndrome. Inform your doctor about any herbal supplements you take to avoid dangerous interactions.
• Medications for mental health disorders: Certain drugs used to treat mental health conditions, such as antipsychotics like chlorpromazine or mood stabilizers like lithium, can have serious interactions with tramadol. Combining them may increase the risk of seizures, drowsiness, and confusion.
• Migraine medications: Tramadol should not be taken with some migraine medications like sumatriptan or rizatriptan as these can also increase the levels of serotonin in the brain. This may provoke serotonin syndrome, especially if the medications are taken in high doses or frequently.
• Sleep medications: Sleep medications like zolpidem (Ambien) or eszopiclone (Lunesta) should be avoided when taking tramadol. Both drugs can cause drowsiness, and when combined with tramadol, they can significantly slow down breathing and heart rate, potentially leading to coma or death.
• Digoxin: Digoxin is a heart medication that helps control heart rate and rhythm. When taken with tramadol, it can increase the levels of digoxin in the body, potentially leading to dangerous heart problems. Your doctor may monitor your heart closely if you need both medications.
• Other pain medications: Non-opioid painkillers like ibuprofen or acetaminophen (Tylenol), are generally safe to take with tramadol in most cases, but you should follow your doctor’s advice. Mixing tramadol with opioid analgesics is dangerous and can increase the risk of overdose.

Always communicate openly with your physician about all medications, vitamins, and supplements you take. This way, your doctor can help you avoid harmful interactions and ensure you’re using tramadol safely.

16 Tramadol Interactions

Tramadol is a powerful medication used to treat pain, but it can have dangerous effects if taken with certain drugs. Understanding how tramadol interacts with other medications can help you use the medication safely and minimize the risk of complications.

1) Benadryl and Tramadol

Benadryl, an over-the-counter antihistamine used to treat allergies, can cause drowsiness. When combined with tramadol, this effect can increase, leading to excessive drowsiness, dizziness, and trouble concentrating. In some cases, this combination may slow your breathing, which can be life-threatening. Avoid using Benadryl and tramadol together unless directed by a doctor.

2) Tramadol and Trazodone

Trazodone is a medication used to treat depression and insomnia. Taking trazodone with tramadol increases the risk of a serious condition called serotonin syndrome. Serotonin syndrome happens when too much serotonin builds up in the brain, causing symptoms like confusion, high blood pressure, increased heart rate, sweating, and tremors. Always talk to your doctor if you’re prescribed both medications to avoid this dangerous side effect.

3) Can You Take Tramadol with Ibuprofen?

You can generally take tramadol with ibuprofen but always check with your doctor first. Tramadol and ibuprofen work in different ways to manage pain, so using them together may provide better relief for certain types of pain. However, taking too much of either can cause side effects, such as stomach upset or, in the case of ibuprofen, gastrointestinal bleeding. Your doctor will guide you on the correct dosages.

4) Tramadol and Hydroxyzine

Hydroxyzine is an antihistamine often used to treat anxiety, allergies, or insomnia. Like Benadryl, hydroxyzine can cause drowsiness, and when taken with tramadol, this drowsiness can intensify. This combination can also slow your breathing and heart rate, making it dangerous without close medical supervision. It’s essential to consult with your doctor before combining these medications.

5) Lexapro and Tramadol

Lexapro is an SSRI used to treat depression and anxiety. Taking Lexapro with tramadol can increase your risk of developing serotonin syndrome. This life-threatening condition can cause agitation, muscle twitching, high blood pressure, and even seizures. If you take Lexapro, inform your doctor before starting tramadol.

6) Can You Take Tramadol with Oxycodone?

You should not take tramadol with oxycodone. Both are opioids and taking them together can lead to dangerous side effects like extreme drowsiness, slow breathing, and even overdose. Because they work similarly, combining them increases the risk of life-threatening respiratory problems. Always follow your doctor’s instructions and avoid taking multiple opioids together. 

7) Tramadol and Tizanidine

Tizanidine is a muscle relaxant used to treat muscle spasms. Combining tizanidine with tramadol can cause severe drowsiness, dizziness, and trouble breathing. This combination may make it unsafe to drive or perform other tasks that require alertness. Always consult your doctor if you’re taking both medications and be aware of how they affect you. 

8) Can I Take Tramadol with Naproxen?

Tramadol and naproxen can be taken together, but only under a doctor’s supervision. Naproxen is an NSAID (nonsteroidal anti-inflammatory drug) that reduces inflammation and pain. Taking naproxen with tramadol may help improve pain relief, especially for conditions like arthritis or muscle injuries. However, using NSAIDs for long periods can increase the risk of stomach ulcers and bleeding, so always use them as directed by your doctor.

9) Tramadol and Wellbutrin

Wellbutrin is a medication used to treat depression and to help people quit smoking. Taking tramadol with Wellbutrin increases the risk of seizures. Both drugs lower the seizure threshold, meaning they make it easier for seizures to occur. If you need both medications, your doctor will monitor you closely to ensure your safety and may adjust the dosages to reduce your risk.

10) Can I Take Tramadol with Xanax?

Taking tramadol with Xanax can be dangerous. Xanax is a benzodiazepine used to treat anxiety, and both Xanax and tramadol can cause sedation and slow breathing. When taken together, these effects can become life-threatening. This combination significantly increases the risk of respiratory failure, coma, or overdose. If you’re prescribed both medications, talk to your doctor about safer alternatives.

11) Tramadol and Eliquis

Eliquis is a blood thinner used to prevent blood clots. Combining tramadol with Eliquis may increase your risk of bleeding. While tramadol itself doesn’t directly thin the blood, it can sometimes interact with medications like Eliquis to heighten the risk of complications like internal bleeding. Tell your doctor if you’re taking both drugs so they can monitor you closely for signs of bleeding.

12) Can You Take Gabapentin with Tramadol?

Use gabapentin and tramadol with caution. Gabapentin is used to treat nerve pain and seizures, and when combined with tramadol, it can cause increased drowsiness, dizziness, and trouble concentrating. In rare cases, combining these drugs can slow your breathing and increase the risk of overdose. Your doctor will adjust your doses to minimize these risks and monitor you closely if both medications are necessary.

13) Can You Take Tramadol with Hydrocodone?

You should not take tramadol with hydrocodone. Like tramadol, hydrocodone is an opioid pain medication, and taking the two together can cause extreme drowsiness, slow breathing, and increase the risk of overdose. Mixing opioids is dangerous, so avoid combining these two medications unless directed by a healthcare professional.

14) Can You Take Tylenol with Tramadol?

You can usually take Tylenol (acetaminophen) with tramadol. The combination is often used to treat moderate to severe pain, as the medications work in different ways. Tylenol reduces pain and fever, while tramadol changes how the brain responds to pain signals. Stick to the recommended doses to avoid liver damage from Tylenol or other side effects from tramadol.

15) Tramadol and Percocet

Percocet is a combination of oxycodone (an opioid) and acetaminophen (Tylenol). It’s not safe to take tramadol and Percocet together because both contain opioids, which can cause serious side effects like slowed breathing, extreme drowsiness, and overdose. If you’re already taking Percocet for pain, do not take tramadol unless your doctor specifically advises it. 

16) Can You Take Tramadol with Flexeril?

Flexeril is a muscle relaxant that helps relieve muscle spasms. Taking Flexeril with tramadol can increase drowsiness and dizziness, making driving or operating machinery dangerous. Both drugs affect the CNS, so using them together increases the risk of serious side effects like slow breathing and confusion. Always consult with your doctor before combining these medications to ensure your safety.

Get Insurance-Covered Addiction Treatment at Renaissance Recovery

Although prescription drug addiction can be disruptive, it’s also highly treatable – we can help you get back on track at Renaissance Recovery.

We treat all addictions, including tramadol addiction, with outpatient programs at our rehabs by the beach in California and Florida. This enables you to live at home and continue at work while getting compassionate treatment for prescription drug addiction.

The unique aspect of all addictions means all Renaissance treatment plans are personalized, including therapies such as:

• Motivational therapy
• Talk therapy
• Medication-assisted treatment
• Counseling
• Group therapy
• Holistic therapies
• Family therapy
• Aftercare

Begin your recovery from tramadol addiction right away by calling 866-330-9449.