TDL Plus Drug Interactions

Use of MAO Inhibitors and Serotonin Reuptake inhibitors: Interaction with MAO Inhibitors has been reported for some centrally-acting drugs. (see Use with MAO Inhibitors and Serotonin Reuptake Inhibitors Use under PRECAUTIONS).
Use with Carbamazepine: Concomitant administration of Tramadol Hydrochloride and Carbamazepine causes a significant increase in Tramadol metabolism. Patients taking Carbamazepine may have a significantly reduced analgesic effect from the Tramadol component of Tramadol + Paracetamol.
Use with Quinidine: Tramadol is metabolized to M1 by CYP2D6. Concomitant administration of quinidine and tramadol results in increased concentrations of Tramadol. The clinical consequences of the findings are unknown.
Use with Warfarin-like Compounds: As medically appropriate, periodic evaluation of prothrombin time should be performed when Tramadol + Paracetamol and these agents are administered concurrently, due to reports of increased international normalized ratio (INR) in some patients.
Use with Inhibitors of CYP2D6: In-vitro interaction studies in human liver microsome indicate that concomitant administration with inhibitors of CYP2D6 such as Fluoxetine, Paroxetine, and Amitriptyline could result in some inhibition of the metabolism of Tramadol.
Use with Cimetidine: Concomitant administration of Tramadol + Paracetamol and Cimetidine has not been studied.
Concomitant administration of Tramadol and Cimetidine does not result in clinically significant changes in Tramadol pharmacokinetics.