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Ultram Disease Interactions

There are 12 disease interactions with Ultram (tramadol).

Major

Opiate agonists (applies to Ultram) gastrointestinal obstruction

Major Potential Hazard, Moderate plausibility.

Opioid agonists are contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
  2. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  3. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  4. "Product Information. Apadaz (acetaminophen-benzhydrocodone)." KemPharm, Inc (2018):
View all 4 references
Major

Tramadol (applies to Ultram) acute alcohol intoxication

Major Potential Hazard, High plausibility. Applicable conditions: Alcoholism

The CNS depressant effects of tramadol may be additive with those of alcohol and may lead to profound sedation, respiratory depression, coma, and death. Therapy with tramadol should be administered cautiously (and only when alternative treatment options are inadequate) in patients who might be prone to acute alcohol intake. Dosages and durations should be limited to the minimum required and patients should be monitored for signs and symptoms of respiratory depression and sedation. Prescribing naloxone for the emergency treatment of opioid overdose should be considered; naloxone will reverse some, but not all, symptoms caused by overdosage with tramadol, but it also increases the risk of seizures.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
Major

Tramadol (applies to Ultram) drug dependence

Major Potential Hazard, High plausibility. Applicable conditions: Alcoholism, Drug Abuse/Dependence, Depression, History - Psychiatric Disorder

Tramadol exposes patients and other users to the risks of addiction, abuse, and misuse. Each patient's risk should be assessed before prescribing tramadol, and all patients should be monitored regularly for development of such behaviors and conditions. Risks are increased in patients with personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (e.g., major depression); the potential for such risks should not prevent proper pain management in any given patient. Patients at increased risk may be prescribed tramadol, but use in such patients requires intensive counseling about the risks and proper use of tramadol, as well as intensive monitoring for signs of addiction, abuse, and misuse; prescribing naloxone for the emergency treatment of opioid overdose should be considered.

Opioids are sought by drug abusers and patients with addiction disorders and are subject to criminal diversion. These risks should be considered when prescribing or dispensing tramadol. Strategies to reduce such risks include prescribing the smallest appropriate quantity and advising the patient about proper disposal of unused drug.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
Major

Tramadol (applies to Ultram) respiratory depression

Major Potential Hazard, Moderate plausibility. Applicable conditions: Pulmonary Impairment, Altered Consciousness, Asphyxia, Brain/Intracranial Tumor, Cerebral Vascular Disorder, Head Injury, Respiratory Arrest, Cachexia, Cor Pulmonale

Tramadol is contraindicated in patients with significant respiratory depression. Serious, life-threatening, or fatal respiratory depression may occur with tramadol. Patients should be monitored closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and after a dosage increase.

The use of tramadol in patients with acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment is contraindicated. Tramadol-treated patients with significant chronic obstructive pulmonary disease or cor pulmonale, and those with substantially decreased respiratory reserve, hypoxia, hypercapnia, or preexisting respiratory depression are at increased risk of decreased respiratory drive (including apnea), even at recommended dosages of tramadol. In patients who may be susceptible to the intracranial effects of carbon dioxide (CO2) retention (e.g., those with evidence of increased intracranial pressure or brain tumors), tramadol may reduce respiratory drive, and the resulting CO2 retention can further increase intracranial pressure; these patients should be monitored for signs of sedation and respiratory depression, especially when starting tramadol.

Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients as they may have altered pharmacokinetics (or altered clearance) compared to younger, healthier patients. These patients should be monitored closely, especially when starting and titrating tramadol and when coadministering with other drugs that depress respiration; alternatively, the use of nonopioid analgesics should be considered.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
Moderate

Tramadol (applies to Ultram) gastrointestinal conditions

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Biliary Obstruction, Gallbladder Disease, Pancreatitis

Tramadol may cause spasm of the sphincter of Oddi. Opioids may increase serum amylase. Patients with biliary tract disease (including acute pancreatitis) should be monitored for worsening symptoms.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
Moderate

Tramadol (applies to Ultram) hypoglycemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

Cases of tramadol-associated hypoglycemia have been reported, some resulting in hospitalization. In most cases, patients had predisposing risk factors (e.g., diabetes); caution is recommended in these patients. If hypoglycemia is suspected, blood glucose levels should be monitored and discontinuation of therapy should be considered as appropriate.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
Moderate

Tramadol (applies to Ultram) hypotension

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Dehydration, Shock

Tramadol may cause severe hypotension (including orthostatic hypotension, syncope) in ambulatory patients. Risk is increased in patients whose ability to maintain blood pressure has already been compromised by reduced blood volume or coadministration of certain CNS depressant drugs; these patients should be monitored for signs of hypotension after starting or titrating tramadol. In patients with circulatory shock, tramadol may cause vasodilation that can further reduce cardiac output and blood pressure; tramadol should be avoided in patients with circulatory shock.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
Moderate

Tramadol (applies to Ultram) intracranial pressure

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Head Injury, Intracranial Hypertension

Opioids may obscure the clinical course in a patient with a head injury. The use of tramadol should be avoided in patients with impaired consciousness or coma.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
Moderate

Tramadol (applies to Ultram) liver disease

Moderate Potential Hazard, High plausibility.

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 liver dysfunction. In patients with severe liver dysfunction, dosage reduction is recommended with the immediate-release formulations, while the extended-release formulations should not be used.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
Moderate

Tramadol (applies to Ultram) renal dysfunction

Moderate Potential Hazard, High plausibility.

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. In patients with CrCl less than 30 mL/min, dosage reduction is recommended with the immediate-release formulations, while the extended-release formulations should not be used.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
Moderate

Tramadol (applies to Ultram) seizure disorders

Moderate Potential Hazard, High plausibility. Applicable conditions: 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 and with concomitant use of certain drugs (e.g., those that reduce the seizure threshold). Risk of seizure may also increase in patients with epilepsy, those with a history of seizures, or in patients with a recognized risk for seizure (e.g., head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infections). In tramadol overdose, naloxone administration may increase the risk of seizures.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
Moderate

Tramadol (applies to Ultram) suicidal

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Depression, Alcoholism, Psychosis

Tramadol should not be prescribed for patients who are suicidal or addiction-prone. The use of nonnarcotic analgesics should be considered for patients who are suicidal or depressed. Tramadol should be prescribed with caution for patients with history of misuse and/or are currently taking CNS-active drugs, antidepressant drugs, alcohol in excess, and patients who suffer from emotional disturbance or depression. Patients should be advised not to exceed the recommended dose and to limit their intake of alcohol.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):

Ultram drug interactions

There are 642 drug interactions with Ultram (tramadol).

Ultram alcohol/food interactions

There is 1 alcohol/food interaction with Ultram (tramadol).


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.