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Drug interactions between Abilify and tramadol

Results for the following 2 drugs:
Abilify (aripiprazole)
tramadol

Interactions between your drugs

Major

traMADol ARIPiprazole

Applies to: tramadol and Abilify (aripiprazole)

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Concomitant use of opioids such as tramadol with other central nervous system (CNS) depressants such as aripiprazole may result in hypotension, profound sedation, respiratory depression, coma, and death.

MONITOR CLOSELY: Tramadol may prolong the QT interval, and while it is uncertain whether aripiprazole causes clinically significant prolongation of the QT interval, coadministration of multiple agents that can prolong the QT interval may theoretically result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. The effect of tramadol on the QT interval was evaluated in a randomized, double-blind, 4-way crossover, placebo- and positive-controlled, multiple-dose ECG study of 62 healthy subjects. The maximum placebo-adjusted mean change from baseline in the Fridericia-corrected QT interval (QTcF) was 5.5 msec in the 400 mg/day treatment arm (100 mg every 6 hours on days 1 through 3 with a single 100 mg dose on day 4) and 6.5 msec in the 600 mg/day treatment arm (150 mg every 6 hours on days 1 through 3 with a single 150 mg dose on day 4), both occurring at the 8-hour time point. In clinical trials with aripiprazole involving patients with schizophrenia or bipolar mania, the incidence of QT prolongation was comparable to placebo. In postmarketing experience, QT prolongation, sudden death, torsade de pointes, ventricular tachycardia, arrhythmia, and cardiopulmonary arrest have been reported. However, these events were very rare or isolated, and many of the patients had preexisting cardiovascular disease, were on concomitant medications known to prolong the QT interval, had risk factors for QT prolongation, took an overdose of aripiprazole, and/or were morbidly obese. On the contrary, most data available in the medical literature suggest that aripiprazole either has no effect on the QT interval, or it may even cause a slight shortening of the QT interval within the dosage range of 10 to 30 mg/day.

MANAGEMENT: The use of tramadol in conjunction with aripiprazole should generally be avoided. If coadministration is necessary, the dosage and duration of each drug should be limited to the minimum required to achieve desired clinical effect. ECG monitoring may be advisable in some cases, such as in patients with a history of cardiac arrhythmias or congenital or family history of long QT syndrome. Particular care should be exercised in patients suspected to be at an increased risk of torsade de pointes. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope. In addition, patients should be monitored closely for signs and symptoms of respiratory depression and sedation, and advised to avoid driving or operating hazardous machinery until they know how these medications affect them.

References

  1. Kane JM, Carson WH, Saha AR, et al. "Efficacy and safety of aripiprazole and haloperidol versus placebo in patients with schizophrenia and schizoaffective disorder." J Clin Psychiatry 63 (2002): 763-71
  2. Keck PE Jr, Marcus R, Tourkodimitris S, et al. "A placebo-controlled, double-blind study of the efficacy and safety of aripiprazole in patients with acute bipolar mania." Am J Psychiatry 160 (2003): 1651-8
  3. Nelson S, Leung JG "Torsades de Pointes After Administration of Low-Dose Aripiprazole (February)." Ann Pharmacother (2013):
  4. Pigott TA, Carson WH, Saha AR, Torbeyns AF, Stock EG, Ingenito GG "Aripiprazole for the prevention of relapse in stabilized patients with chronic schizophrenia: a placebo-controlled 26-week study." J Clin Psychiatry 64 (2003): 1048-56
  5. US Food and Drug Administration "FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. Available from: URL: http://www.fda.gov/downloads/Drugs/DrugSafety/UCM518672.pdf." ([2016, Aug 31]):
  6. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  7. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb, Princeton, NJ.
  8. Cerner Multum, Inc. "Australian Product Information." O 0
  9. Goodnick PJ, Jerry J, Parra F "Psychotropic drugs and the ECG: focus on the QTc interval." Expert Opin Pharmacother 3 (2002): 479-98
View all 9 references

Drug and food interactions

Moderate

traMADol food

Applies to: tramadol

Alcohol can increase the nervous system side effects of traMADol such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with traMADol. Do not use more than the recommended dose of traMADol, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

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Moderate

ARIPiprazole food

Applies to: Abilify (aripiprazole)

Alcohol can increase the nervous system side effects of ARIPiprazole such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with ARIPiprazole. Do not use more than the recommended dose of ARIPiprazole, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

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Therapeutic duplication warnings

No therapeutic duplications were found for your selected drugs.

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
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 information available.

Do not stop taking any medications without consulting your healthcare provider.

Further information

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

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