Drug Interaction Report

MONITOR: Coadministration with drugs that are inhibitors of the CYP450 3A4 isoenzymes may increase the plasma concentrations of tramadol and its active O-demethylated metabolite. The risk of adverse effects including seizures and serotonin syndrome may be increased.

MANAGEMENT: Caution is advised if tramadol is used concomitantly with medications that inhibit CYP450 3A4 metabolism. Dosage adjustments as well as clinical monitoring may be appropriate whenever there drugs are added to or withdrawn from therapy.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.