Ultram (tramadol) Disease Interactions
There are 8 disease interactions with Ultram (tramadol):
- Acute Alcohol Intoxication
- Drug Dependence
- Liver Disease
- Renal Dysfunction
- Seizure Disorders
- Acute Abdominal Conditions
- Intracranial Pressure
- Respiratory Depression
The use of tramadol is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of tramadol may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with tramadol should be administered cautiously in patients who might be prone to acute alcohol intake. Naloxone may only partially reverse clinically significant tramadol-induced respiratory depression while increasing the risk of tramadol-associated seizures.
Tramadol has the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop after prolonged use. Abrupt cessation, reduction in dosage, or administration of an opiate antagonist such as naloxone may precipitate withdrawal symptoms. Tramadol may also reinstate physical dependence in patients previously addicted to or chronically using opioids. Therapy with tramadol is not recommended in patients with a tendency to drug abuse, a history of drug dependence (including alcoholism), or chronic use of opioids. After prolonged use or if dependency is suspected, withdrawal of tramadol therapy should be undertaken gradually using a dosage-tapering schedule.
Tramadol is converted by the liver to several metabolites, one of which (referred to as M1) is pharmacologically active and a more potent analgesic than tramadol itself. The metabolism of both tramadol and M1 has been shown to decrease in patients with advanced cirrhosis of the liver, resulting in increased exposure to tramadol as well as substantially prolonged elimination half-lives for both tramadol and M1. Therapy with tramadol should be administered cautiously in patients with impaired hepatic function. The recommended dosage for patients with cirrhosis is 50 mg every 12 hours.
Tramadol and its metabolites, one of which (referred to as M1) is pharmacologically active and a more potent analgesic than tramadol itself, are primarily excreted in the urine. The rate and extent of excretion of both tramadol and M1 have been shown to decrease in patients with impaired renal function. Therapy with tramadol should be administered cautiously in such patients. The manufacturer recommends increasing the dosing interval to every 12 hours, with a maximum daily dosage of 200 mg, in patients with creatinine clearance below 30 mL/min.
Seizures have been reported in patients receiving tramadol within the recommended dosage range. The risk appears to increase with doses above the recommended range. Therapy with tramadol should be administered cautiously in patients with epilepsy, a history of seizures, or other predisposing factors for seizures, including underlying neurologic abnormalities such as head trauma, brain damage or CNS tumor; excessive use of or abrupt withdrawal from alcohol; addiction to opiates, cocaine, or stimulants; and concomitant use of medications that lower seizure threshold. In tramadol overdose, naloxone administration may also increase the risk of seizures.
The use of tramadol may complicate the clinical assessment of patients with acute abdominal conditions. Therapy with tramadol should be administered cautiously in such patients.
Tramadol may induce pupillary changes (miosis) that may obscure the existence, extent, or course of intracranial pathology. Therapy with tramadol should be administered cautiously in patients with increased intracranial pressure or head injury. Clinicians should maintain a high index of suspicion for adverse drug reaction when evaluating altered mental status in these patients if they are treated with tramadol.
Tramadol may produce some respiratory depression, but less than morphine at recommended dosages. Respiratory depression most often occurs when tramadol is given in high dosages with anesthetic medications or alcohol. Tramadol may also increase airway resistance, which can result in dyspnea. In general, the respiratory effects at therapeutic analgesic dosages are not clinically important except in some patients with preexisting pulmonary impairment. Therapy with tramadol should be administered cautiously in patients with underlying CNS and respiratory depression; sleep apnea; hypoxia, anoxia, or hypercapnia; upper airway obstruction; chronic pulmonary insufficiency; a limited ventilatory reserve; or other respiratory disorders. Caution is also advised in patients who may be at increased risk for respiratory depression, such as comatose patients or those with head injury, intracranial lesions, or intracranial hypertension. If clinically significant respiratory depression occurs, naloxone may be administered. However, it may only partially antagonize the effects of tramadol while increasing the risk of tramadol-associated seizures.
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Ultram (tramadol) drug Interactions
There are 651 drug interactions with Ultram (tramadol)
Ultram (tramadol) alcohol/food Interactions
There is 1 alcohol/food interaction with Ultram (tramadol)
Drug Interaction Classification
The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
|Major||Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderate||Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|Minor||Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.|
Do not stop taking any medications without consulting your healthcare provider.
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