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Tramapap (acetaminophen / tramadol) Disease Interactions

There are 11 disease interactions with Tramapap (acetaminophen / tramadol):

Major

Acetaminophen (Includes Tramapap) ↔ Alcoholism

Severe Potential Hazard, High plausibility

Applies to: Alcoholism

Chronic alcohol abusers may be at increased risk of hepatotoxicity during treatment with acetaminophen (APAP). Severe liver injury, including cases of acute liver failure resulting in liver transplant and death, has been reported in patients using acetaminophen. Therapy with acetaminophen should be administered cautiously, if at all, in patients who consume three or more alcoholic drinks a day. In general, patients should avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure. They should also be advised to seek medical attention if they experience signs and symptoms of liver injury such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.

References

  1. Whitcomb DC, Block GD "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA 272 (1994): 1845-50
  2. Bonkovsky HL "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  3. Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med 145 (1985): 2019-23
View all 11 references
Major

Acetaminophen (Includes Tramapap) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Acetaminophen is primarily metabolized in the liver to inactive forms. However, small quantities are converted by minor pathways to metabolites that can cause hepatotoxicity or methemoglobinemia. Patients with hepatic impairment may be at increased risk of toxicity due to increased minor metabolic pathway activity. Likewise, chronic or overuse of acetaminophen can saturate the primary hepatic enzymes and lead to increased metabolism by minor pathways. Severe liver injury, including cases of acute liver failure resulting in liver transplant and death, has been reported in patients using acetaminophen. Therapy with acetaminophen should be administered cautiously in patients with hepatic insufficiency. Clinical monitoring of hepatic function is recommended. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.

References

  1. Gillette JR "An integrated approach to the study of chemically reactive metabolites of acetaminophen." Arch Intern Med 141 (1981): 375-9
  2. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical, Raritan, NJ.
  3. Clements JA, Critchley JA, Prescott LF "The role of sulphate conjugation in the metabolism and disposition of oral and intravenous paracetamol in man." Br J Clin Pharmacol 18 (1984): 481-5
View all 6 references
Major

Tramadol (Includes Tramapap) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Alcoholism, Acute Alcohol Intoxication

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.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical, Raritan, NJ.
  2. Kahn LH, Alderfer RJ, Graham DJ "Seizures reported with tramadol." JAMA 278 (1997): 1661
Major

Tramadol (Includes Tramapap) ↔ Drug Dependence

Severe Potential Hazard, High plausibility

Applies to: Alcoholism, Drug Abuse/Dependence

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.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical, Raritan, NJ.
  2. Brinker A, Bonnel RA, Beitz J "Abuse, dependence, or withdrawal associated with tramadol." Am J Psychiatry 159 (2002): 881; discussion 881-2
Major

Tramadol (Includes Tramapap) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

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.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical, Raritan, NJ.
Major

Tramadol (Includes Tramapap) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

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.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical, Raritan, NJ.
Major

Tramadol (Includes Tramapap) ↔ Seizure Disorders

Severe Potential Hazard, High plausibility

Applies to: Alcoholism, Drug Abuse/Dependence, CNS Disorder

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.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical, Raritan, NJ.
Moderate

Acetaminophen (Includes Tramapap) ↔ Pku

Moderate Potential Hazard, High plausibility

Applies to: Phenylketonuria

Several oral acetaminophen and acetaminophen-combination products, particularly flavored chewable tablets, contain the artificial sweetener, aspartame (NutraSweet). Aspartame is converted to phenylalanine in the gastrointestinal tract following ingestion. Chewable and effervescent formulations of acetaminophen products may also contain phenylalanine. The aspartame/phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

References

  1. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical, Raritan, NJ.
Moderate

Tramadol (Includes Tramapap) ↔ Acute Abdominal Conditions

Moderate Potential Hazard, High plausibility

Applies to: Acute (Surgical) Abdomen

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.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical, Raritan, NJ.
Moderate

Tramadol (Includes Tramapap) ↔ Intracranial Pressure

Moderate Potential Hazard, Moderate plausibility

Applies to: Head Injury, Intracranial Hypertension

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.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical, Raritan, NJ.
Moderate

Tramadol (Includes Tramapap) ↔ Respiratory Depression

Moderate Potential Hazard, Moderate plausibility

Applies to: Pulmonary Impairment, Altered Consciousness, Asphyxia, Brain/Intracranial Tumor, Cerebral Vascular Disorder, Head Injury, Respiratory Arrest, Sleep Apnea

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.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical, Raritan, NJ.

Tramapap (acetaminophen / tramadol) drug Interactions

There are 828 drug interactions with Tramapap (acetaminophen / tramadol)

Tramapap (acetaminophen / tramadol) alcohol/food Interactions

There is 1 alcohol/food interaction with Tramapap (acetaminophen / 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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