Tramadol
Opioid, Analgesic
Tramadol
Ultram
Experience
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Effects
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Interactions
Pharmacogenomic + mechanism interactions
FDA Boxed WarningHighest-evidence regulatory action
CPIC rec 8095039 [Strong]: Avoid tramadol use because of possibility of diminished analgesia. If opioid use is warranted, consider a non-codeine opioid. CPIC pair-level A (CYP2D6, OPRM1, COMT, and Opioids) [PMID 33387367] FDA labeling (boxed: Boxed Warning, Warnings and Precautions, Use in Specific Populations, Clinical P)
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CPIC rec 8095040 [Strong]: Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid. CPIC pair-level A (CYP2D6, OPRM1, COMT, and Opioids) [PMID 33387367] FDA labeling (boxed: Boxed Warning, Warnings and Precautions, Use in Specific Populations, Clinical P)
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Pharmacogenomic guideline recommendationsCPIC and Dutch Pharmacogenetics Working Group clinical guidelines
CPIC rec 8095035 [Strong]: Use tramadol label recommended age- or weight-specific dosing. CPIC pair-level A (CYP2D6, OPRM1, COMT, and Opioids) [PMID 33387367]
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CPIC rec 8095032 [Optional]: Use tramadol label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine opioid. CPIC pair-level A (CYP2D6, OPRM1, COMT, and Opioids) [PMID 33387367]
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Clinical relevance: does this interaction matter in practice?trivialcritical
Mechanism description, if it needs work:
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Your own experience with this combination:
Experience (1 a little, 5 a lot)
Outcome (-100 worst, +100 best)
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Summary
Classes
Opioid, Analgesic
Pharmacy
Pharmacology
Purported mechanism
Mu-opioid agonist; serotonin–norepinephrine reuptake inhibitor