Tramadol
Brand: Ultram (discontinued; generic only)
Boxed warning · ISMP high-alert drug
Addiction, abuse, and misuse; life-threatening respiratory depression; profound sedation and death with benzodiazepines or other CNS depressants; neonatal opioid withdrawal syndrome with prolonged use in pregnancy. Also ultra-rapid metabolism to an active form causing respiratory depression in children; contraindicated under age 12.
- Caution
- Seizures and serotonin syndrome, especially with SSRIs, SNRIs, or high doses.
- Pregnancy
- Prolonged use in pregnancy causes neonatal opioid withdrawal syndrome (boxed).
Common side effects
- Dizziness
- Nausea
- Constipation
- Drowsiness
- Headache
Key interactions
- Serotonin syndrome risk with SSRIs and SNRIs
- Adds to alcohol and other sedatives
- Seizure risk rises with other seizure-threshold-lowering drugs (antidepressants, antipsychotics)
- Avoid MAO inhibitors
- CYP3A4 inducers (rifampin, carbamazepine, phenobarbital, St. John's wort) lower its levels
Counseling points
- May cause drowsiness; use caution driving
- Do not drink alcohol
- Can be habit-forming
- Report seizures or severe agitation
- Do not stop abruptly after long use
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