Interaction Checker

Tramadol and acetaminophen interactions

Tramadol and acetaminophen (Ultracet), an opioid has 461 documented interactions across the FDA labels and fact sheets we index: 290 major, 151 moderate, 16 minor, and 4 where a label reports no significant interaction. Each entry below quotes the sentence behind it. This drug page is a starting point, not a verdict for your situation.

Interactions from the label

Major interactions (290)

  • AbirateroneCYP2D6 inhibitorMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • AcetaminophenMajor

    A baby nursing from an ultra-rapid metabolizer mother taking tramadol hydrochloride and acetaminophen could potentially be exposed to high levels of M1, and experience life-threatening respiratory depression. (Tramadol and acetaminophen label, Warnings and precautions)

  • Acetaminophen and codeineopioidMajor

    At least one death was reported in a nursing infant who was exposed to high levels of morphine in breast milk because the mother was an ultra-rapid metabolizer of codeine. (Tramadol and acetaminophen label, Warnings and precautions)

  • Acetaminophen and ibuprofenNSAIDMajor

    A baby nursing from an ultra-rapid metabolizer mother taking tramadol hydrochloride and acetaminophen could potentially be exposed to high levels of M1, and experience life-threatening respiratory depression. (Tramadol and acetaminophen label, Warnings and precautions)

  • AcetylcysteineMajor

    Hypersensitivity Reactions Serious acute hypersensitivity reactions; including fatal or life-threatening anaphylaxis, rash, hypotension, wheezing, and/or shortness of breath; have been observed in patients receiving intravenous acetylcysteine for acetaminophen overdose and occurred soon after initiation of the infusion [ see Adverse Reactions ( 6 ) ]. (Acetylcysteine label, Warnings and precautions)

  • AlcoholAlcoholMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • AlprazolambenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Alvimopanopioid antagonistMajor

    Alvimopan capsules are contraindicated in patients who have taken therapeutic doses of opioids for more than 7 consecutive days immediately prior to taking alvimopan capsules [see Warnings and Precautions ( 5.3 )]. (Alvimopan label, Contraindications)

  • AmiodaroneantiarrhythmicMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Amitriptylinetricyclic antidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Amoxapinetricyclic antidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • AmphetamineCNS stimulantMajor

    Serotonin Syndrome: Increased risk when co-administered with serotonergic agents (e.g., SSRIs, SNRIs, triptans), but also during overdosage situations. (Amphetamine label, Warnings and precautions)

  • Amphetamine and dextroamphetamineCNS stimulantMajor

    Serotonin Syndrome: Increased risk when coadministered with serotonergic agents (e.g., selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), triptans), but also during overdosage situations. (Amphetamine and dextroamphetamine label, Warnings and precautions)

  • AprepitantCYP3A4 inhibitorMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • AripiprazoleantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ArmodafinilCNS stimulantMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • AsenapineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • AtazanavirantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • AzelastineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Azelastine and fluticasoneantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Azithromycinmacrolide antibioticMajor

    This risk which can be fatal should be considered in patients with certain cardiovascular disorders including known QT prolongation or history torsades de pointes, those with proarrhythmic conditions, and with other drugs that prolong the QT interval. (Azithromycin label, Warnings and precautions)

  • Baclofenmuscle relaxantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Belladonna and opiumopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • Bictegravir, emtricitabine, and tenofovir alafenamideantiretroviralMajor

    Opioid Antagonist: Naloxegol ↑ naloxegol Avoid use with BIXLENVO; if unavoidable, decrease the dosage of naloxegol and monitor for adverse reactions. (Bictegravir, emtricitabine, and tenofovir alafenamide label, Drug interactions)

  • BosentanCYP3A4 inducerMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • BrexpiprazoleantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • BrivaracetamanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Brompheniramine, pseudoephedrine, and dextromethorphanantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • BuprenorphineopioidMajor

    Additionally, avoid the use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving a full opioid agonist analgesic, including tramadol hydrochloride and acetaminophen. (Tramadol and acetaminophen label, Warnings and precautions)

  • Buprenorphine and naloxoneopioidMajor

    Additionally, avoid the use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving a full opioid agonist analgesic, including tramadol hydrochloride and acetaminophen. (Tramadol and acetaminophen label, Warnings and precautions)

  • BupropionantidepressantMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Buspironeserotonergic drugMajor

    Serotonin Syndrome The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs SSRIs, and other serotonergic drugs, including buspirone, alone but particularly with concomitant use of other serotonergic drugs (including triptans), with drugs that impair metabolism of serotonin (in particular, MAOIs, including reversible MAOIs… (Buspirone label, Warnings)

  • Butalbital and acetaminophenbarbiturateMajor

    A baby nursing from an ultra-rapid metabolizer mother taking tramadol hydrochloride and acetaminophen could potentially be exposed to high levels of M1, and experience life-threatening respiratory depression. (Tramadol and acetaminophen label, Warnings and precautions)

  • Butalbital, acetaminophen, and caffeinebarbiturateMajor

    A baby nursing from an ultra-rapid metabolizer mother taking tramadol hydrochloride and acetaminophen could potentially be exposed to high levels of M1, and experience life-threatening respiratory depression. (Tramadol and acetaminophen label, Warnings and precautions)

  • Butalbital, acetaminophen, caffeine, and codeinebarbiturateMajor

    At least one death was reported in a nursing infant who was exposed to high levels of morphine in breast milk because the mother was an ultra-rapid metabolizer of codeine. (Tramadol and acetaminophen label, Warnings and precautions)

  • Butalbital, aspirin, and caffeinebarbiturateMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Butalbital, aspirin, caffeine, and codeinebarbiturateMajor

    Nursing Mothers Tramadol is subject to the same polymorphic metabolism as codeine, with ultra-rapid metabolizers of CYP2D6 substrates being potentially exposed to life-threatening levels of O -desmethyltramadol (M1). (Tramadol and acetaminophen label, Warnings and precautions)

  • ButorphanolopioidMajor

    Additionally, avoid the use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving a full opioid agonist analgesic, including tramadol hydrochloride and acetaminophen. (Tramadol and acetaminophen label, Warnings and precautions)

  • Cannabidiol (prescription)anticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • CarbamazepineanticonvulsantMajor

    Because carbamazepine increases tramadol metabolism and because of the seizure risk associated with tramadol, concomitant administration of tramadol hydrochloride and acetaminophen and carbamazepine is not recommended. (Tramadol and acetaminophen label, Drug interactions)

  • CarbinoxamineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • CariprazineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Carisoprodolmuscle relaxantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • CenobamateanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • CetirizineantihistamineMajor

    Avoid concurrent use of QUZYTTIR with alcohol or other CNS depressants because additional reduction in alertness and additional impairment of CNS performance may occur. (Cetirizine label, Warnings and precautions)

  • ChlordiazepoxidebenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Chlordiazepoxide and clidiniumbenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ChlorpheniramineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ChlorpromazineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Chlorzoxazonemuscle relaxantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • CimetidineH2 blockerMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • CinacalcetCYP2D6 inhibitorMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • CiprofloxacinfluoroquinoloneMajor

    Avoid use in patients with known prolongation, those with hypokalemia, and with other drugs that prolong the QT interval. (Ciprofloxacin label, Warnings and precautions)

  • CitalopramSSRIMajor

    Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Citalopram label, Warnings and precautions)

  • Clarithromycinmacrolide antibioticMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • ClemastineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ClobazambenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Clomipraminetricyclic antidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ClonazepambenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Clonidinealpha-adrenergic agonistMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ClorazepatebenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ClozapineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • CodeineopioidMajor

    Nursing Mothers Tramadol is subject to the same polymorphic metabolism as codeine, with ultra-rapid metabolizers of CYP2D6 substrates being potentially exposed to life-threatening levels of O -desmethyltramadol (M1). (Tramadol and acetaminophen label, Warnings and precautions)

  • Cyclobenzaprinemuscle relaxantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • CyclosporineimmunosuppressantMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • CyproheptadineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Dantrolenemuscle relaxantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Daridorexantsedative-hypnoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • DarifenacinanticholinergicMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • DarunavirantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Darunavir and cobicistatantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Deferasiroxiron supplementMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Desfluranegeneral anestheticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Desipraminetricyclic antidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • DesvenlafaxineSNRIMajor

    • Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Desvenlafaxine label, Warnings and precautions)

  • DexamethasonecorticosteroidMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • DexchlorpheniramineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Dexmedetomidinealpha-adrenergic agonistMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • DextroamphetamineCNS stimulantMajor

    Serotonin Syndrome Serotonin syndrome, a potentially life-threatening reaction, may occur when amphetamines are used in combination with other drugs that affect the serotonergic neurotransmitter systems such as monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), triptans,… (Dextroamphetamine label, Warnings)

  • Dextromethorphan and quinidineserotonergic drugMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • DiazepambenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Diltiazemcalcium channel blockerMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • DimenhydrinateantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • DiphenhydramineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Diphenoxylate and atropineMajor

    CONTRAINDICATIONS Diphenoxylate hydrochloride and atropine sulfate is contraindicated in: • Pediatric patients less than 6 years of age due to the risks of respiratory and central nervous system (CNS) depression (see WARNINGS ). (Diphenoxylate and atropine label, Contraindications)

  • Divalproex (valproate)anticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • DofetilideantiarrhythmicMajor

    Use with Drugs that Prolong QT Interval and Antiarrhythmic Agents The use of dofetilide in conjunction with other drugs that prolong the QT interval has not been studied and is not recommended. (Dofetilide label, Warnings)

  • Doxepintricyclic antidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • DoxylamineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Doxylamine and pyridoxineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • DronabinolcannabinoidMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • DronedaroneantiarrhythmicMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Droperidoldopamine antagonistMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • DuloxetineSNRIMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • EfavirenzantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Efavirenz, lamivudine, and tenofovirantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • EluxadolineopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • Elvitegravir, cobicistat, emtricitabine, and tenofovirantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Emtricitabine, rilpivirine, and tenofovirantiretroviralMajor

    Concomitant use of COMPLERA with drugs with a known risk to prolong the QTc interval of the electrocardiogram may increase the risk of Torsade de Pointes. (Emtricitabine, rilpivirine, and tenofovir label, Warnings and precautions)

  • Erythromycinmacrolide antibioticMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • EscitalopramSSRIMajor

    Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents but also when taken alone. (Escitalopram label, Warnings and precautions)

  • EslicarbazepineanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • EstazolambenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Eszopiclonesedative-hypnoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • EthosuximideanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Etomidategeneral anestheticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • EtravirineantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • EverolimusimmunosuppressantMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • FelbamateanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • FentanylopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • FlibanserinCNS depressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Fluconazoleazole antifungalMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • FlumazenilbenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • FluoxetineSSRIMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • FluphenazineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • FluvoxamineSSRIMajor

    If concomitant use of Fluvoxamine Maleate Tablets with other serotonergic drugs is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases. (Fluvoxamine label, Warnings and precautions)

  • FosamprenavirantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • FosaprepitantCYP3A4 inhibitorMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • FoscarnetantiviralMajor

    (See DOSAGE and ADMINISTRATION. ) Because of the risk of QT prolongation and the potential for torsades de pointes, the use of FOSCAVIR should be avoided in combination with agents known to prolong the QT interval including Class IA (e.g., quinidine or procainamide) or Class III (e.g., dofetilide, amiodarone, sotalol) antiarrhythmic agents, phenothiazines, tricyclic… (Foscarnet label, Drug interactions)

  • FosfomycinantibioticMajor

    Avoid co-administration of CONTEPO with drugs known to prolong the QT interval. (Fosfomycin label, Drug interactions)

  • FosphenytoinanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • GabapentinanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • GranisetronQT-prolonging drugMajor

    Patients should be monitored for the emergence of serotonin syndrome, especially with concomitant use of granisetron and other serotonergic drugs. (Granisetron label, Warnings and precautions)

  • GriseofulvinantifungalMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Guanfacinealpha-adrenergic agonistMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • HaloperidolantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • HydrocodoneopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • Hydrocodone and acetaminophenopioidMajor

    A baby nursing from an ultra-rapid metabolizer mother taking tramadol hydrochloride and acetaminophen could potentially be exposed to high levels of M1, and experience life-threatening respiratory depression. (Tramadol and acetaminophen label, Warnings and precautions)

  • Hydrocodone and chlorpheniramineopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • Hydrocodone and homatropineopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • Hydrocodone and ibuprofenopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • HydromorphoneopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • HydroxychloroquineQT-prolonging drugMajor

    Therefore, PLAQUENIL is not recommended in patients taking other drugs that have the potential to prolong the QT interval. (Hydroxychloroquine label, Warnings and precautions)

  • HydroxyzineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • IloperidoneantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ImatinibCYP3A4 inhibitorMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Imipraminetricyclic antidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Isofluranegeneral anestheticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • IsoniazidantibioticMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Itraconazoleazole antifungalMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • IvabradineMajor

    Bradycardia may increase the risk of QT prolongation which may lead to severe ventricular arrhythmias, including torsade de pointes, especially in patients with risk factors such as use of QTc prolonging drugs [see Adverse Reactions ( 6.2 )] . (Ivabradine label, Warnings and precautions)

  • IvacaftorCYP3A4 inhibitorMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • KetamineCNS depressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Ketoconazoleazole antifungalMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • KetorolacNSAIDMajor

    BOXED WARNING Ketorolac tromethamine tablets, a nonsteroidal anti-inflammatory drug (NSAID), are indicated for the short-term (up to 5 days in adults), management of moderately severe acute pain that requires analgesia at the opioid level and only as continuation treatment following IV or IM dosing of ketorolac tromethamine, if necessary. (Ketorolac label, Boxed warning)

  • LacosamideanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Lemborexantsedative-hypnoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • LenacapavirantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • LevetiracetamanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • LevocetirizineantihistamineMajor

    Avoid concurrent use of alcohol or other central nervous system depressants with XYZAL. (Levocetirizine label, Warnings and precautions)

  • LevofloxacinfluoroquinoloneMajor

    Avoid use in patients with known prolongation, those with hypokalemia, and with other drugs that prolong the QT interval ( 5.11 , 8.5 ) (Levofloxacin label, Warnings and precautions)

  • LevomilnacipranSNRIMajor

    Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Levomilnacipran label, Warnings and precautions)

  • LevorphanolopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • LinezolidantibioticMajor

    Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within the last 14 days [see Drug Interactions (7) ]. (Tramadol and acetaminophen label, Contraindications)

  • LisdexamfetamineCNS stimulantMajor

    Serotonin Syndrome: Increased risk when co-administered with serotonergic agents (e.g., SSRIs, SNRIs, triptans), but also during overdosage situations. (Lisdexamfetamine label, Warnings and precautions)

  • Lithiumserotonergic drugMajor

    If concomitant use of lithium with other serotonergic drugs is clinically warranted, inform patients of the increased risk for serotonin syndrome and monitor for symptoms. (Lithium label, Warnings and precautions)

  • Lofexidinealpha-adrenergic agonistMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Lopinavir and ritonavirantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • LorazepambenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • LorlatinibCYP3A4 inducerMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • LoxapineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • LumateperoneantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • LurasidoneantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • MeclizineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • MeperidineopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • MeprobamateCNS depressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Metaxalonemuscle relaxantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • MethadoneopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • MethamphetamineCNS stimulantMajor

    Serotonin Syndrome: Increased risk when coadministered with serotonergic agents (e.g., SSRIs, SNRIs, triptans), but also during overdosage situations. (Methamphetamine label, Warnings and precautions)

  • Methocarbamolmuscle relaxantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • MethohexitalbarbiturateMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • MethsuximideanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Methylene blueMAO inhibitorMajor

    Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within the last 14 days [see Drug Interactions (7) ]. (Tramadol and acetaminophen label, Contraindications)

  • Methylnaltrexoneopioid antagonistMajor

    • Other Opioid Antagonists : Potential for additive effect and increased risk of opioid withdrawal; avoid concomitant use. (Methylnaltrexone label, Drug interactions)

  • Metoclopramidedopamine antagonistMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • MetyraponeMajor

    Acetaminophen: Avoid concomitant use with Metopirone. (Metyrapone label, Drug interactions)

  • MidazolambenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • MifepristoneCYP3A4 inhibitorMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • MilnacipranSNRIMajor

    • Serotonin Syndrome : Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Milnacipran label, Warnings and precautions)

  • Mirabegronbeta-adrenergic agonistMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • MirtazapineantidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • MitapivatCYP3A4 inducerMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • MitotaneCYP3A4 inducerMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • ModafinilCNS stimulantMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • MorphineopioidMajor

    At least one death was reported in a nursing infant who was exposed to high levels of morphine in breast milk because the mother was an ultra-rapid metabolizer of codeine. (Tramadol and acetaminophen label, Warnings and precautions)

  • Nafcillinpenicillin antibioticMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • NalbuphineopioidMajor

    Additionally, avoid the use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving a full opioid agonist analgesic, including tramadol hydrochloride and acetaminophen. (Tramadol and acetaminophen label, Warnings and precautions)

  • Naldemedineopioid antagonistMajor

    Intervention Avoid use of SYMPROIC with another opioid antagonist. (Naldemedine label, Drug interactions)

  • Nalmefeneopioid antagonistMajor

    Risk of Recurrent Respiratory and CNS Depression : A recurrence of respiratory depression is possible, therefore, keep the patient under continued surveillance and administer repeat doses of ZURNAI using a new auto-injector with each dose while awaiting emergency medical assistance. (Nalmefene label, Warnings and precautions)

  • Naloxegolopioid antagonistMajor

    …concomitantly using strong CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole) because these medications can significantly increase exposure to naloxegol which may precipitate opioid withdrawal symptoms such as hyperhidrosis, chills, diarrhea, abdominal pain, anxiety, irritability, and yawning [see Drug Interactions (7.1) and Clinical Pharmacology (12.3)… (Naloxegol label, Contraindications)

  • Naloxoneopioid antagonistMajor

    In neonates, opioid withdrawal may be life-threatening if not recognized and properly treated. (Naloxone label, Warnings and precautions)

  • Naltrexoneopioid antagonistMajor

    Naltrexone for extended-release injectable suspension is contraindicated in: Patients receiving opioid analgesics [see Warnings and Precautions ( 5.3 ) ] . (Naltrexone label, Contraindications)

  • Naltrexone and bupropionopioid antagonistMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • NefazodoneantidepressantMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • NevirapineantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • NilotinibQT-prolonging drugMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Nirmatrelvir and ritonavirantiviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Nortriptylinetricyclic antidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • OlanzapineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Olanzapine and fluoxetineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • OliceridineopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • OlopatadineantihistamineMajor

    • Avoid concurrent use of alcohol or other central nervous system depressants with olopatadine hydrochloride nasal solution (nasal spray) ( 5.2 ). (Olopatadine label, Warnings and precautions)

  • Olopatadine and mometasoneantihistamineMajor

    • Avoid concurrent use of alcohol or other central nervous system (CNS) depressants with RYALTRIS because additional reductions in alertness and additional impairment of CNS performance may occur. (Olopatadine and mometasone label, Warnings and precautions)

  • OndansetronQT-prolonging drugMajor

    Patients should be monitored for the emergence of serotonin syndrome, especially with concomitant use of Ondansetron Injection and other serotonergic drugs. (Ondansetron label, Warnings and precautions)

  • Orphenadrinemuscle relaxantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Orphenadrine, aspirin, and caffeinemuscle relaxantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • OxaliplatinMajor

    Avoid coadministration of oxaliplatin injection with medicinal products with a known potential to prolong the QT interval. (Oxaliplatin label, Drug interactions)

  • OxazepambenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • OxcarbazepineanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • OxycodoneopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • Oxycodone and acetaminophenopioidMajor

    A baby nursing from an ultra-rapid metabolizer mother taking tramadol hydrochloride and acetaminophen could potentially be exposed to high levels of M1, and experience life-threatening respiratory depression. (Tramadol and acetaminophen label, Warnings and precautions)

  • OxymorphoneopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • PalbociclibCYP3A4 inhibitorMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • PaliperidoneantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Palonosetronserotonergic drugMajor

    Patients should be monitored for the emergence of serotonin syndrome, especially with concomitant use of POSFREA and other serotonergic drugs. (Palonosetron label, Warnings and precautions)

  • ParoxetineSSRIMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • PazopanibMajor

    Avoid coadministration of VOTRIENT with drugs known to prolong the QT/QTc interval. (Pazopanib label, Drug interactions)

  • Pentazocine and naloxoneopioidMajor

    Additionally, avoid the use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving a full opioid agonist analgesic, including tramadol hydrochloride and acetaminophen. (Tramadol and acetaminophen label, Warnings and precautions)

  • PerampanelanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • PerphenazineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • PhenelzineMAO inhibitorMajor

    Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within the last 14 days [see Drug Interactions (7) ]. (Tramadol and acetaminophen label, Contraindications)

  • PhenobarbitalbarbiturateMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Phenobarbital, hyoscyamine, atropine, and scopolaminebarbiturateMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Phentermine and topiramateCNS stimulantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • PhenytoinanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • PimavanserinantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • PimozideantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • PitolisantQT-prolonging drugMajor

    The use of WAKIX should be avoided in patients with known QT prolongation or in combination with other drugs known to prolong the QT interval [see Drug Interactions ( 7.1 )]. (Pitolisant label, Warnings and precautions)

  • Posaconazoleazole antifungalMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Pramipexoledopamine agonistMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • PregabalinanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • PrimidoneanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ProchlorperazineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • PromethazineantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Promethazine and codeineopioidMajor

    Nursing Mothers Tramadol is subject to the same polymorphic metabolism as codeine, with ultra-rapid metabolizers of CYP2D6 substrates being potentially exposed to life-threatening levels of O -desmethyltramadol (M1). (Tramadol and acetaminophen label, Warnings and precautions)

  • Promethazine and dextromethorphanantihistamineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • PropafenoneantiarrhythmicMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • PropofolCNS depressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Protriptylinetricyclic antidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • QuetiapineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • QuinidineantiarrhythmicMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Ramelteonsedative-hypnoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • RanolazineQT-prolonging drugMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • RasagilineMAO inhibitorMajor

    Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within the last 14 days [see Drug Interactions (7) ]. (Tramadol and acetaminophen label, Contraindications)

  • RemifentanilopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • RifabutinantibioticMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • RifampinantibioticMajor

    Examples: Rifampin, carbamazepine, phenytoin Benzodiazepines and Other Central Nervous System (CNS) Depressants Clinical Impact: Due to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants, including alcohol, can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death. (Tramadol and acetaminophen label, Drug interactions)

  • RifapentineantibioticMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • RisperidoneantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • RitonavirantiretroviralMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • RolapitantCYP2D6 inhibitorMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Ropiniroledopamine agonistMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • RufinamideanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ScopolamineanticholinergicMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • SelegilineMAO inhibitorMajor

    Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within the last 14 days [see Drug Interactions (7) ]. (Tramadol and acetaminophen label, Contraindications)

  • SertralineSSRIMajor

    Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Sertraline label, Warnings and precautions)

  • Sevofluranegeneral anestheticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Sodium oxybateCNS depressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • St. John's wortHerbal and supplementMajor

    Combining St. John's wort with antidepressants and other serotonergic drugs increases the risk of serotonin syndrome. (NCCIH, St. John's Wort)

  • Suvorexantsedative-hypnoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • SuzetrigineCYP3A4 inducerMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • TapentadolopioidMajor

    …TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN TABLETS Addiction, Abuse, and Misuse Because the use of tramadol hydrochloride and acetaminophen exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of… (Tramadol and acetaminophen label, Boxed warning)

  • Tasimelteonsedative-hypnoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • TemazepambenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • TerbinafineantifungalMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • TetrabenazineVMAT2 inhibitorMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ThioridazineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ThiothixeneantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • TiagabineanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Ticagrelorantiplatelet agentMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • Tizanidinemuscle relaxantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • TopiramateanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • TramadolopioidMajor

    A baby nursing from an ultra-rapid metabolizer mother taking tramadol hydrochloride and acetaminophen could potentially be exposed to high levels of M1, and experience life-threatening respiratory depression. (Tramadol and acetaminophen label, Warnings and precautions)

  • TranylcypromineMAO inhibitorMajor

    Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within the last 14 days [see Drug Interactions (7) ]. (Tramadol and acetaminophen label, Contraindications)

  • TrazodoneantidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • TriazolambenzodiazepineMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • TrifluoperazineantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Trimipraminetricyclic antidepressantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Valproic acidanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • VenlafaxineSNRIMajor

    If concomitant use of Venlafaxine Extended Release Tablets with other serotonergic drugs is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases. (Venlafaxine label, Warnings and precautions)

  • VepdegestrantMajor

    Avoid concomitant use of VEPPANU with strong CYP3A inhibitors or drugs known to prolong the QTc interval. (Vepdegestrant label, Warnings and precautions)

  • Verapamilcalcium channel blockerMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • VigabatrinanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • VilazodoneSSRIMajor

    Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Vilazodone label, Warnings and precautions)

  • Voriconazoleazole antifungalMajor

    Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (Tramadol and acetaminophen label, Boxed warning)

  • VortioxetineantidepressantMajor

    • Serotonin Syndrome : Increased risk when coadministered with other serotonergic agents, but also when taken alone. (Vortioxetine label, Warnings and precautions)

  • Zaleplonsedative-hypnoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ZiprasidoneantipsychoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • Zolpidemsedative-hypnoticMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

  • ZonisamideanticonvulsantMajor

    Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol and acetaminophen label, Boxed warning)

Moderate interactions (151)

  • Acetazolamidecarbonic anhydrase inhibitorModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • AclidiniumanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • AlemtuzumabimmunosuppressantModerate

    Premedicate patients with an antihistamine and acetaminophen prior to each dose. (Alemtuzumab label, Warnings and precautions)

  • Allopurinolxanthine oxidase inhibitorModerate

    Inform patients also that the central nervous system depressant effects of allopurinol tablets may be additive to those of alcohol and other CNS depressants. (Allopurinol label, Warnings and precautions)

  • AlmotriptantriptanModerate

    Serotonin Syndrome Risk Cases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol, including tramadol hydrochloride and acetaminophen, during concomitant use with serotonergic drugs. (Tramadol and acetaminophen label, Warnings and precautions)

  • AmantadineanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Amiloridepotassium-sparing diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • AminophyllinemethylxanthineModerate

    25% increase Diazepam Benzodiazepines increase CNS concentrations of adenosine, a potent CNS depressant, while theophylline blocks adenosine receptors. (Aminophylline label, Drug interactions)

  • Arformoterolbeta-adrenergic agonistModerate

    MAO inhibitors, tricyclic antidepressants and drugs that prolong the QTc interval may potentiate effect on the cardiovascular system. (Arformoterol label, Drug interactions)

  • Articaine and epinephrinelocal anestheticModerate

    …Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine Monoamine Oxidase Inhibitors, Nonselective Beta-Adrenergic Antagonists, or Tricyclic Antidepressants: May produce severe, prolonged… (Articaine and epinephrine label, Drug interactions)

  • Atenolol and chlorthalidonebeta blockerModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Atomoxetinenorepinephrine reuptake inhibitorModerate

    …inhibitors, or 2D6 inhibitors with tramadol hydrochloride and acetaminophen requires careful consideration of the effects on the parent drug, tramadol, which is a weak serotonin and norepinephrine reuptake inhibitor and μ-opioid agonist, and the active metabolite, M1, which is more potent than tramadol in μ-opioid receptor binding [see Drug Interactions (7) ] . (Tramadol and acetaminophen label, Warnings and precautions)

  • AtropineanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Atropine and pralidoximeanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • BeclomethasonecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Benazepril and hydrochlorothiazideACE inhibitorModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • BenztropineanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • BetamethasonecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Bismuth subcitrate, metronidazole, and tetracyclineantibioticModerate

    Drugs that Prolong the QT interval QT prolongation has been reported with metronidazole, a component of bismuth subcitrate potassium, metronidazole and tetracycline hydrochloride, particularly when administered with drugs with the potential for prolonging the QT interval. (Bismuth subcitrate, metronidazole, and tetracycline label, Warnings and precautions)

  • Bisoprolol and hydrochlorothiazidebeta blockerModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Brimonidinealpha-adrenergic agonistModerate

    Use with CNS depressants may result in an additive or potentiating effect. (Brimonidine label, Drug interactions)

  • Brimonidine and timololalpha-adrenergic agonistModerate

    Use with CNS depressants may result in an additive or potentiating effect. (Brimonidine and timolol label, Drug interactions)

  • BudesonidecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Budesonide and formoterolcorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Bumetanideloop diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Bupivacainelocal anestheticModerate

    Possible early warning signs of central nervous system (CNS) toxicity are restlessness, anxiety, incoherent speech, lightheadedness, numbness and tingling of the mouth and lips, metallic taste, tinnitus, dizziness, blurred vision, tremors, twitching, CNS depression, or drowsiness. (Bupivacaine label, Warnings and precautions)

  • Bupivacaine and epinephrinelocal anestheticModerate

    …Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine 7.6 Potent Inhalation Anesthetics Serious dose-related cardiac arrhythmias may occur if preparations containing a vasoconstrictor… (Bupivacaine and epinephrine label, Drug interactions)

  • Candesartan and hydrochlorothiazideangiotensin II receptor blocker (ARB)Moderate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Chloroprocainelocal anestheticModerate

    …procaine, ropivacaine, tetracaine Antineoplastic agents cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants Phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine (Chloroprocaine label, Precautions)

  • Chlorothiazidethiazide diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Chlorthalidonethiazide diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • CiclesonidecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • ClobetasolcorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Clopidogrelantiplatelet agentModerate

    Opioids: Decreased exposure to clopidogrel. (Clopidogrel label, Drug interactions)

  • Clotrimazoleazole antifungalModerate

    Cytochrome P450 3A4 Interaction The concomitant use of tramadol hydrochloride and acetaminophen with cytochrome P450 3A4 inhibitors, such as macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), and protease inhibitors (e.g., ritonavir) or discontinuation of a cytochrome P450 3A4 inducer such as rifampin, carbamazepine, and phenytoin,… (Tramadol and acetaminophen label, Warnings and precautions)

  • CyclopentolateanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • DeflazacortcorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • DesmopressinModerate

    …Hyponatremia Concomitant administration of DESMODA with other drugs that may increase the risk of water intoxication with hyponatremia, (e.g., tricyclic antidepressants, selective serotonin re-uptake inhibitors, chlorpromazine, opiate analgesics, thiazide diuretics, NSAIDs, lamotrigine, sulfonylureas, particularly chlorpropamide, oxybutynin and carbamazepine). (Desmopressin label, Drug interactions)

  • Desogestrel and ethinyl estradioloral contraceptiveModerate

    Ascorbic acid and acetaminophen may increase plasma EE concentrations, possibly by inhibition of conjugation. (Desogestrel and ethinyl estradiol label, Drug interactions)

  • DesonidecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • DeutetrabenazineVMAT2 inhibitorModerate

    Alcohol or other sedating drugs: May have additive sedation and somnolence ( 7.5 ) (Deutetrabenazine label, Drug interactions)

  • DiclofenacNSAIDModerate

    Exercise caution when prescribing ZIPSOR with concomitant drugs that are known to be potentially hepatotoxic (e.g., acetaminophen, antibiotics, antiepileptics). (Diclofenac label, Warnings and precautions)

  • DicyclomineanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Difenoxin and atropineModerate

    MOTOFEN ® may potentiate the action of barbiturates, tranquilizers, narcotics, and alcohol. (Difenoxin and atropine label, Drug interactions)

  • DiflunisalNSAIDModerate

    Acetaminophen In normal volunteers, concomitant administration of diflunisal and acetaminophen resulted in an approximate 50% increase in plasma levels of acetaminophen. (Diflunisal label, Drug interactions)

  • Digoxindigitalis glycosideModerate

    Digoxin Clinical Impact: Post-marketing surveillance of tramadol has revealed rare reports of digoxin toxicity. (Tramadol and acetaminophen label, Drug interactions)

  • DisopyramideantiarrhythmicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Drospirenone and ethinyl estradioloral contraceptiveModerate

    Ascorbic acid and acetaminophen may increase plasma EE concentrations, possibly by inhibition of conjugation. (Drospirenone and ethinyl estradiol label, Drug interactions)

  • Econazoleazole antifungalModerate

    Cytochrome P450 3A4 Interaction The concomitant use of tramadol hydrochloride and acetaminophen with cytochrome P450 3A4 inhibitors, such as macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), and protease inhibitors (e.g., ritonavir) or discontinuation of a cytochrome P450 3A4 inducer such as rifampin, carbamazepine, and phenytoin,… (Tramadol and acetaminophen label, Warnings and precautions)

  • EletriptantriptanModerate

    Serotonin Syndrome Risk Cases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol, including tramadol hydrochloride and acetaminophen, during concomitant use with serotonergic drugs. (Tramadol and acetaminophen label, Warnings and precautions)

  • Enalapril and hydrochlorothiazideACE inhibitorModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Eplerenonealdosterone antagonistModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • EribulinModerate

    QT Prolongation: Monitor for prolonged QT intervals in patients with congestive heart failure, bradyarrhythmias, drugs known to prolong the QT interval, and electrolyte abnormalities. (Eribulin label, Warnings and precautions)

  • Ethacrynic acidloop diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Etonogestrel and ethinyl estradiolestrogenModerate

    Ascorbic acid and acetaminophen may increase plasma ethinyl estradiol concentrations, possibly by inhibition of conjugation. (Etonogestrel and ethinyl estradiol label, Drug interactions)

  • FesoterodineanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Fidaxomicinmacrolide antibioticModerate

    Cytochrome P450 3A4 Interaction The concomitant use of tramadol hydrochloride and acetaminophen with cytochrome P450 3A4 inhibitors, such as macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), and protease inhibitors (e.g., ritonavir) or discontinuation of a cytochrome P450 3A4 inducer such as rifampin, carbamazepine, and… (Tramadol and acetaminophen label, Warnings and precautions)

  • FlavoxateanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • FludrocortisonecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • FlunisolidecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • FluocinonidecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • FluticasonecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Fluticasone and salmeterolcorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Formoterolbeta-adrenergic agonistModerate

    …Antidepressants, QTc Prolonging Drugs Formoterol, as with other beta 2 -agonists, should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors, tricyclic antidepressants, or drugs known to prolong the QTc interval because the effect of adrenergic agonists on the cardiovascular system may be potentiated by these agents. (Formoterol label, Drug interactions)

  • Fosinopril and hydrochlorothiazideACE inhibitorModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • FrovatriptantriptanModerate

    Serotonin Syndrome Risk Cases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol, including tramadol hydrochloride and acetaminophen, during concomitant use with serotonergic drugs. (Tramadol and acetaminophen label, Warnings and precautions)

  • Furosemideloop diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • GlycopyrrolateanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • GoserelinModerate

    Effect on QT/QTc Interval: Androgen deprivation therapy may prolong the QT interval. (Goserelin label, Warnings and precautions)

  • HalobetasolcorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Hydrochlorothiazidethiazide diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • HydrocortisonecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • HyoscyamineanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Indapamidethiazide diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • InfliximabimmunosuppressantModerate

    Medications for the treatment of hypersensitivity reactions (e.g., acetaminophen, antihistamines, corticosteroids and/or epinephrine) should be available for immediate use in the event of a reaction [see Dosage and Administration (2.10) and Adverse Reactions (6.1) ] . (Infliximab label, Warnings and precautions)

  • IpratropiumanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Ipratropium and albuterolanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Irbesartan and hydrochlorothiazideangiotensin II receptor blocker (ARB)Moderate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • LapatinibP-glycoprotein inhibitorModerate

    TYKERB may prolong the QT interval in some patients. (Lapatinib label, Warnings and precautions)

  • LeuprolideModerate

    Effect on QT/QTc Interval: Androgen deprivation therapy may prolong the QT interval. (Leuprolide label, Warnings and precautions)

  • Levonorgestrel and ethinyl estradioloral contraceptiveModerate

    Ascorbic acid and acetaminophen may increase systemic exposure of ethinyl estradiol, possibly by inhibition of conjugation. (Levonorgestrel and ethinyl estradiol label, Drug interactions)

  • Lidocaine and epinephrinelocal anestheticModerate

    …Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine 7.6 Potent Inhalation Anesthetics Serious dose-related cardiac arrhythmias may occur if preparations containing epinephrine are… (Lidocaine and epinephrine label, Drug interactions)

  • Lidocaine and prilocainelocal anestheticModerate

    …prilocaine, procaine, ropivacaine, tetracaine Antineoplastic agents cyclophosphamide, flutamide, hydroxyurea, isofamide, rasburicase Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sufonamides Antimalarials chloroquine, primaquine Anticonvulsants Phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine (Lidocaine and prilocaine label, Drug interactions)

  • Lisinopril and hydrochlorothiazideACE inhibitorModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • LomitapideModerate

    Caution should be exercised when JUXTAPID is used with other medications known to have potential for hepatotoxicity, such as isotretinoin, amiodarone, acetaminophen (>4 g/day for ≥3 days/week), methotrexate, tetracyclines, and tamoxifen. (Lomitapide label, Warnings and precautions)

  • Losartan and hydrochlorothiazideangiotensin II receptor blocker (ARB)Moderate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • LubiprostoneModerate

    Methadone Diphenylheptane opioids (e.g., methadone) have been shown in nonclinical studies to dose-dependently reduce the activation of ClC-2 by lubiprostone in the gastrointestinal tract. (Lubiprostone label, Drug interactions)

  • MefloquineantimalarialModerate

    Other Drugs that Prolong the QTc Interval Coadministration of other drugs known to alter cardiac conduction (e.g., anti-arrhythmic or beta-adrenergic blocking agents, calcium channel blockers, antihistamines or H 1 -blocking agents, tricyclic antidepressants and phenothiazines) might also contribute to a prolongation of the QTc interval. (Mefloquine label, Drug interactions)

  • Mepivacainelocal anestheticModerate

    …procaine, ropivacaine, tetracaine Antineoplastic agents cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine (Mepivacaine label, Drug interactions)

  • MethscopolamineanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • MethylprednisolonecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Metolazonethiazide diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Metoprolol and hydrochlorothiazidebeta blockerModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • MetronidazoleantibioticModerate

    Drugs that Prolong the QT Interval QT prolongation has been reported, particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval. (Metronidazole label, Drug interactions)

  • MetyrosineModerate

    Concurrent use of metyrosine with alcohol or other CNS depressants can increase their sedative effects. (Metyrosine label, Drug interactions)

  • Miconazoleazole antifungalModerate

    Cytochrome P450 3A4 Interaction The concomitant use of tramadol hydrochloride and acetaminophen with cytochrome P450 3A4 inhibitors, such as macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), and protease inhibitors (e.g., ritonavir) or discontinuation of a cytochrome P450 3A4 inducer such as rifampin, carbamazepine, and phenytoin,… (Tramadol and acetaminophen label, Warnings and precautions)

  • MometasonecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • MotixafortideModerate

    Premedicate with an analgesic medication (e.g., acetaminophen) prior to each APHEXDA dose. (Motixafortide label, Warnings and precautions)

  • MoxifloxacinfluoroquinoloneModerate

    Pharmacokinetic studies between moxifloxacin and other drugs that prolong the QT interval such as cisapride, erythromycin, antipsychotics, and tricyclic antidepressants have not been performed. (Moxifloxacin label, Warnings and precautions)

  • NaratriptantriptanModerate

    Serotonin Syndrome Risk Cases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol, including tramadol hydrochloride and acetaminophen, during concomitant use with serotonergic drugs. (Tramadol and acetaminophen label, Warnings and precautions)

  • Nifedipinedihydropyridine calcium channel blockerModerate

    The interaction with high-dose fentanyl appears to be due to the combination of nifedipine and a beta-blocker, but the possibility that it may occur with nifedipine alone, with low doses of fentanyl, in other surgical procedures, or with other narcotic analgesics cannot be ruled out. (Nifedipine label, Warnings)

  • Norelgestromin and ethinyl estradiolestrogenModerate

    Ascorbic acid and acetaminophen may increase plasma EE concentrations, possibly by inhibition of conjugation. (Norelgestromin and ethinyl estradiol label, Drug interactions)

  • Norethindrone and ethinyl estradioloral contraceptiveModerate

    Ascorbic acid and acetaminophen may increase plasma ethinyl estradiol levels, possibly by inhibition of conjugation. (Norethindrone and ethinyl estradiol label, Drug interactions)

  • Norgestimate and ethinyl estradioloral contraceptiveModerate

    Ascorbic acid and acetaminophen may increase plasma EE concentrations, possibly by inhibition of conjugation. (Norgestimate and ethinyl estradiol label, Drug interactions)

  • Norgestrel and ethinyl estradioloral contraceptiveModerate

    Ascorbic acid and acetaminophen may increase plasma EE concentrations, possibly by inhibition of conjugation. (Norgestrel and ethinyl estradiol label, Drug interactions)

  • OcrelizumabimmunosuppressantModerate

    The addition of an antipyretic (e.g., acetaminophen) may also be considered [see Dosage and Administration (2.2) ]. (Ocrelizumab label, Warnings and precautions)

  • Olmesartan and hydrochlorothiazideangiotensin II receptor blocker (ARB)Moderate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Olmesartan, amlodipine, and hydrochlorothiazideangiotensin II receptor blocker (ARB)Moderate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • OxybutyninanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • PasireotideModerate

    Drugs that Prolong QT: Use with caution in patients who are at significant risk of developing QTc prolongation. (Pasireotide label, Drug interactions)

  • PonesimodimmunosuppressantModerate

    Anti-Arrhythmic Drugs, QT Prolonging Drugs, Drugs that may Decrease Heart Rate PONVORY has not been studied in patients taking QT prolonging drugs. (Ponesimod label, Drug interactions)

  • Prasugrelantiplatelet agentModerate

    Opioids: Decreased exposure to prasugrel. (Prasugrel label, Drug interactions)

  • PrednisolonecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • PrednisonecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Prilocaine and epinephrinelocal anestheticModerate

    …Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine The administration of local anesthetic injections containing epinephrine or norepinephrine to patients receiving monoamine oxidase… (Prilocaine and epinephrine label, Drug interactions)

  • PrimaquineantimalarialModerate

    QT Interval Prolonging Drugs The pharmacodynamic interaction potential to prolong the QT interval of the electrocardiogram between Primaquine phosphate Tablets and other drugs that effect cardiac conduction is unknown. (Primaquine label, Drug interactions)

  • ProbenecidModerate

    In patients on probenecid who require a mild analgesic agent the use of acetaminophen rather than small doses of salicylates would be preferred. (Probenecid label, Warnings)

  • Probenecid and colchicineModerate

    In patients on probenecid and colchicine who require a mild analgesic agent the use of acetaminophen rather than small doses of salicylates would be preferred. (Probenecid and colchicine label, Warnings)

  • Quinapril and hydrochlorothiazideACE inhibitorModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • RilpivirineantiretroviralModerate

    In healthy subjects, 75 mg once daily and 300 mg once daily (3 times and 12 times the dose in EDURANT) have been shown to prolong the QTc interval of the electrocardiogram. (Rilpivirine label, Warnings and precautions)

  • RizatriptantriptanModerate

    Serotonin Syndrome Risk Cases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol, including tramadol hydrochloride and acetaminophen, during concomitant use with serotonergic drugs. (Tramadol and acetaminophen label, Warnings and precautions)

  • Rocuroniumneuromuscular blockerModerate

    QT Interval Prolongation The overall analysis of ECG data in pediatric patients indicates that the concomitant use of Rocuronium Bromide Injection with general anesthetic agents can prolong the QTc interval [see Clinical Studies ( 14.3 )]. (Rocuronium label, Warnings and precautions)

  • Ropivacainelocal anestheticModerate

    …Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants Phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine NAROPIN should be used with caution in patients receiving other local anesthetics or agents structurally related to amide- type… (Ropivacaine label, Drug interactions)

  • SolifenacinanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • SolriamfetolCNS stimulantModerate

    …inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol hydrochloride and acetaminophen requires careful consideration of the effects on the parent drug, tramadol, which is a weak serotonin and norepinephrine reuptake inhibitor and μ-opioid agonist, and the active metabolite, M1, which is more potent than tramadol in μ-opioid receptor binding [see Drug Interactions… (Tramadol and acetaminophen label, Warnings and precautions)

  • SorafenibModerate

    Monitor electrolytes and electrocardiograms in patients with congestive heart failure, bradyarrhythmias, drugs known to prolong the QT interval, including Class Ia and III antiarrhythmics. (Sorafenib label, Warnings and precautions)

  • Sotalolbeta blockerModerate

    Additive to other QT-prolonging drugs ( 7.1 , 7.2 ) (Sotalol label, Drug interactions)

  • Spironolactonealdosterone antagonistModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Spironolactone and hydrochlorothiazidealdosterone antagonistModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • SumatriptantriptanModerate

    Serotonin Syndrome Risk Cases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol, including tramadol hydrochloride and acetaminophen, during concomitant use with serotonergic drugs. (Tramadol and acetaminophen label, Warnings and precautions)

  • Sumatriptan and naproxentriptanModerate

    Serotonin Syndrome Risk Cases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol, including tramadol hydrochloride and acetaminophen, during concomitant use with serotonergic drugs. (Tramadol and acetaminophen label, Warnings and precautions)

  • SunitinibModerate

    Drugs that Prolong QT Interval SUTENT is associated with QTc interval prolongation [see Warnings and Precautions (5.3) , Clinical Pharmacology (12.2) ] . (Sunitinib label, Drug interactions)

  • Telmisartan and hydrochlorothiazideangiotensin II receptor blocker (ARB)Moderate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • TheophyllinemethylxanthineModerate

    25% increase Diazepam Benzodiazepines increase CNS concentrations of adenosine, a potent CNS depressant, while theophylline blocks adenosine receptors. (Theophylline label, Drug interactions)

  • TiotropiumanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • TolterodineanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Torsemideloop diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • TriamcinolonecorticosteroidModerate

    If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. (Tramadol and acetaminophen label, Warnings and precautions)

  • Triamterenepotassium-sparing diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Triamterene and hydrochlorothiazidepotassium-sparing diureticModerate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • TrihexyphenidylanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • TrimethobenzamideModerate

    The recent use of other drugs that cause CNS depression or EPS symptoms may also increase the risk; consider reducing the dosage or discontinuing the drug. (Trimethobenzamide label, Warnings and precautions)

  • TriptorelinModerate

    Effect on QT/QTc Interval: Androgen deprivation therapy may prolong the QT interval. (Triptorelin label, Warnings and precautions)

  • TrospiumanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • UmeclidiniumanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Umeclidinium and vilanterolanticholinergicModerate

    Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Tramadol and acetaminophen label, Drug interactions)

  • Valsartan and hydrochlorothiazideangiotensin II receptor blocker (ARB)Moderate

    Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

  • Viloxazinenorepinephrine reuptake inhibitorModerate

    …inhibitors, or 2D6 inhibitors with tramadol hydrochloride and acetaminophen requires careful consideration of the effects on the parent drug, tramadol, which is a weak serotonin and norepinephrine reuptake inhibitor and μ-opioid agonist, and the active metabolite, M1, which is more potent than tramadol in μ-opioid receptor binding [see Drug Interactions (7) ] . (Tramadol and acetaminophen label, Warnings and precautions)

  • WarfarinanticoagulantModerate

    Intervention: Frequently reevaluate the prothrombin time of patients on warfarin for signs of an interaction and adjust the dosage of warfarin as needed. (Tramadol and acetaminophen label, Drug interactions)

  • ZenocutuzumabModerate

    Prior to the first BIZENGRI infusion, premedicate with a corticosteroid, an H1 antihistamine and acetaminophen to reduce the risk of IRRs [see Dosage and Administration (2.4) ]. (Zenocutuzumab label, Warnings and precautions)

  • ZolmitriptantriptanModerate

    Serotonin Syndrome Risk Cases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol, including tramadol hydrochloride and acetaminophen, during concomitant use with serotonergic drugs. (Tramadol and acetaminophen label, Warnings and precautions)

Minor mentions (16)

  • ArgatrobananticoagulantMinor

    Aspirin/Acetaminophen No drug-drug interactions have been demonstrated between argatroban and concomitantly administered aspirin or acetaminophen [ see Clinical Pharmacology (12.3) ]. (Argatroban label, Drug interactions)

  • CidofovirantiviralMinor

    Drug Interactions Probenecid Probenecid is known to interact with the metabolism or renal tubular excretion of many drugs (e.g., acetaminophen, acyclovir, angiotensin-converting enzyme inhibitors, aminosalicylic acid, barbiturates, benzodiazepines, bumetanide, clofibrate, methotrexate, famotidine, furosemide, nonsteroidal anti-inflammatory agents, theophylline,… (Cidofovir label, Drug interactions)

  • Dihydroergotamineergot alkaloidMinor

    Medication Overuse Headache Overuse of acute migraine drugs (e.g., ergotamines, triptans, opioids, or a combination of these drugs for 10 or more days per month) may lead to exacerbation of headache (i.e., medication overuse headache). (Dihydroergotamine label, Warnings)

  • DobutaminesympathomimeticMinor

    Drug Interactions There was no evidence of drug interactions in clinical studies in which dobutamine was administered concurrently with other drugs, including digitalis preparations, furosemide, spironolactone, lidocaine, glyceryl trinitrate, isosorbide dinitrate, morphine, atropine, heparin, protamine, potassium chloride, folic acid, and acetaminophen. (Dobutamine label, Drug interactions)

  • DoxapramMinor

    In Postanesthetic Use Doxapram is neither an antagonist to muscle relaxant drugs nor a specific narcotic antagonist. (Doxapram label, Warnings)

  • Epoetin alfaMinor

    The “gasping syndrome” is characterized by central nervous system (CNS) depression, metabolic acidosis, and gasping respirations. (Epoetin alfa label, Warnings and precautions)

  • ExenatideGLP-1 receptor agonistMinor

    Orally Administered Drugs (e.g., acetaminophen) Clinical Impact Exenatide slows gastric emptying. (Exenatide label, Drug interactions)

  • Finasteride5-alpha reductase inhibitorMinor

    Other Concomitant Therapy Although specific interaction studies were not performed, PROSCAR was concomitantly used in clinical studies with acetaminophen, acetylsalicylic acid, α-blockers, angiotensin-converting enzyme (ACE) inhibitors, analgesics, anti-convulsants, beta-adrenergic blocking agents, diuretics, calcium channel blockers, cardiac nitrates, HMG-CoA… (Finasteride label, Drug interactions)

  • LenalidomideMinor

    Patients with Grade 1 and 2 TFR may also be treated with corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) and/or narcotic analgesics for management of TFR symptoms. (Lenalidomide label, Warnings and precautions)

  • OfloxacinfluoroquinoloneMinor

    Interaction With Laboratory or Diagnostic Testing Some quinolones, including ofloxacin, may produce false-positive urine screening results for opiates using commercially available immunoassay kits. (Ofloxacin label, Precautions)

  • PhentermineCNS stimulantMinor

    The safety and efficacy of combination therapy with phentermine and any other drug products for weight loss including prescribed drugs, over-the-counter preparations, and herbal products, or serotonergic agents such as selective serotonin reuptake inhibitors (e.g., fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. (Phentermine label, Warnings and precautions)

  • Prazosinalpha blockerMinor

    …to date with the following: (1) cardiac glycosides– digitalis and digoxin; (2) hypoglycemics–insulin, chlorpropamide, phenformin, tolazamide, and tolbutamide; (3) tranquilizers and sedatives–chlordiazepoxide, diazepam, and phenobarbital; (4) antigout–allopurinol, colchicine, and probenecid; (5) antiarrhythmics–procainamide, propranolol (see WARNINGS however),… (Prazosin label, Drug interactions)

  • Pyridostigminecholinesterase inhibitorMinor

    Narcotics: Exacerbation of bradycardia possible. (Pyridostigmine label, Drug interactions)

  • RituximabimmunosuppressantMinor

    Premedicate patients with an antihistamine and acetaminophen prior to dosing. (Rituximab label, Warnings and precautions)

  • Telmisartan and amlodipineangiotensin II receptor blocker (ARB)Minor

    Other Drugs: Co-administration of telmisartan did not result in a clinically significant interaction with acetaminophen, amlodipine, glyburide, simvastatin, hydrochlorothiazide, warfarin, or ibuprofen. (Telmisartan and amlodipine label, Drug interactions)

  • Treprostinilprostaglandin analogMinor

    Effect of Other Drugs on Treprostinil Drug interaction studies have been carried out with treprostinil (oral or subcutaneous) co-administered with acetaminophen (4 g/day), warfarin (25 mg/day), and fluconazole (200 mg/day), respectively, in healthy volunteers. (Treprostinil label, Drug interactions)

No significant interaction reported (4)

  • Montelukastleukotriene receptor antagonistNo interaction

    …adjustment is needed when SINGULAIR is co-administered with theophylline, prednisone, prednisolone, oral contraceptives, fexofenadine, digoxin, warfarin, gemfibrozil, itraconazole, thyroid hormones, sedative hypnotics, non-steroidal anti-inflammatory agents, benzodiazepines, decongestants, and Cytochrome P450 (CYP) enzyme inducers [see Clinical Pharmacology (12.3) ]. (Montelukast label, Drug interactions)

  • OseltamivirantiviralNo interaction

    …Clinically Significant Drug Interaction with TAMIFLU No dose adjustments are needed for either oseltamivir or the concomitant drug when coadministering oseltamivir with amoxicillin, acetaminophen, aspirin, cimetidine, antacids (magnesium and aluminum hydroxides and calcium carbonates), rimantadine, amantadine, or warfarin [see Clinical Pharmacology (12.3) ] . (Oseltamivir label, Drug interactions)

  • RaltegravirantiretroviralNo interaction

    Based on these data, ISENTRESS is not expected to affect the pharmacokinetics of drugs that are substrates of these enzymes or P-glycoprotein (e.g., protease inhibitors, NNRTIs, opioid analgesics, statins, azole antifungals, proton pump inhibitors and anti-erectile dysfunction agents). (Raltegravir label, Drug interactions)

  • SulindacNSAIDNo interaction

    Acetaminophen Acetaminophen had no effect on the plasma levels of sulindac or its sulfide metabolite. (Sulindac label, Drug interactions)

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Not medical advice. Severity reflects the label's wording, not your circumstances. A "major" flag can be routine under supervision and a "minor" one can matter at high doses. Ask a pharmacist.