Interactions

Drug-Drug

• ↑ risk of CNS depression when used concurrently with other CNS depressants , including alcohol , antihistamines , sedative/hypnotics , opioid analgesics , anesthetics , or psychotropic agents

• ↑ risk of seizures with high doses of penicillins , cephalosporins , phenothiazines , opioid analgesics , or antidepressants

• Carbamazepine ↑ metabolism and ↓ effectiveness of tramadol (increased doses may be required)

• Use cautiously in patients who are receiving MAO inhibitors (↑ risk of adverse reactions)

• Quinidine , fluoxetine , paroxetine , amitriptyline , ketoconazole , and erythromycin may ↑ levels

• ↑ risk of serotonin syndrome when used with SSRI and SNRI antidepressants , TCAs , MAO inhibitors and 5HT1 agonists

• Concomitant use of kava , valerian , or chamomile can ↑ CNS depression

• ↑ risk of serotonin syndrome when used with St. Johns' wort

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