Dromadol SR - y Dr. prescribed Tramadol for my pain, but I take Wafarin for blood clots. Is tramadol safe to take with this?
4 Jun 2011
The following interaction warning exists for tramadol and warfarin:
Interactions between your selected drugs
warfarin ↔ tramadol
Applies to: warfarin, Ultram ER (tramadol)
MONITOR: Coadministration with tramadol may potentiate the hypoprothrombinemic effect of warfarin. There have been rare reports of elevated prothrombin time or INR and bleeding in warfarin patients taking tramadol, and a return to normal anticoagulation following its discontinuation. The exact mechanism is unknown but may be related to reduced activity of CYP450 2D6, which can lead to increased plasma concentrations of tramadol. In a retrospective analysis of 17 cases of suspected interaction between tramadol and warfarin that were reported to the Swedish Adverse Drug Reactions Advisory Committee between 1995 and 2003, INR increases were observed between 1.5 to 60 days following initiation of tramadol therapy (mean 13 days). The recorded INR values ranged from 3.4 to greater than 8.5, and bleeding complications occurred in 6 patients (35%). In cases where follow-up information was available, INR values decreased within 1 to 11 days following tramadol withdrawal. In ten cases where genotypes were available for known polymorphisms of several CYP450 isoenzymes that are associated with reduced or absent enzyme activities, seven patients were found to carry a defective CYP450 2D6 allele. A further patient received concomitant drug treatments that may have resulted in CYP450 2D6 inhibition. Although not statistically significant, this finding suggests a higher prevalence of defective alleles compared to the general Swedish population average of 42.2%.
MANAGEMENT: Given the potential for interaction and the high degree of interpatient variability with respect to warfarin metabolism, patients should be closely monitored during concomitant therapy with tramadol. The INR should be checked frequently and warfarin dosage adjusted accordingly, particularly following initiation, discontinuation or change of dosage of tramadol in patients who are stabilized on their warfarin regimen. The same precaution may be applicable during therapy with other oral anticoagulants, although clinical data are lacking. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.
You will need to have your prothrombin levels checked frequently while taking, changing dose or discontinuing tramadol.
Best wishes and please post if you have further questions,
4 Jun 2011
hey sg,how are you 2day ?? Great i hope... i noticed and read the first anser and that seems like a lot of risks,cld u not possibly get something else for pain??? I mean with all the diffrent things that cld happen i wld try to get something else ??? Tramadol is about as good as a goodypowder
5 Jun 2011
Hi SG! 3 years ago I had a blood clot lodged in my right lung. I took Coumadin (Warfarin). I also took Tramacet (which has Tramadol in it) daily for my pain regimen. After a year, I discontinued use of the Coumadin.
In March, I had another blood clot, however, this time in my leg (DVT). So, I'm back on Coumadin. Presently, I take Cymbalta 60 mg. for my chronic daily pain & can add Tramacet as required, which I have been doing.
I have had no problems with the combination of the 2 medications. My INR is checked on a regular basis. As long as you keep an eye on things, you shouldn't have too many problems SG.
I live in Canada & I can ask my pharmacy if there should be any cause for concern with my prescriptions & any interactions. Along with that, the doctor shouldn't prescribe anything without knowledge of any of your medications, vitamins & herbal supplements that you use on a regular basis.
There are many different pain drugs available so switching shouldn't be a problem if you choose to do so.
I do find that Tramacet helps me & have had no issues with the combination of the 2 prescriptions.
All the best SG! Good luck with your health management. from Wendy :)
- Tramadol Information for Consumers
- Tramadol Information for Healthcare Professionals (includes dosage details)
- Side Effects of Tramadol (detailed)
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