Documented interactions for Ultram, Tramadol (Tramadol HCl (immediate-release tablet)). Each entry cites the prescribing information or FDA safety communication it is based on.
| Severity | Interacts with | Class | Concern |
|---|---|---|---|
| Contraindicated | MAO inhibitors (phenelzine, tranylcypromine, linezolid, methylene blue) | Monoamine oxidase inhibitor | Tramadol with MAO inhibitors is contraindicated |
| Contraindicated | MAO inhibitors (phenelzine, tranylcypromine, linezolid, methylene blue) | Monoamine oxidase inhibitor | Opioid with MAO inhibitors is contraindicated |
| Major | Alcohol (ethanol) | CNS depressant | Tramadol with alcohol: additive CNS and respiratory depression |
| Major | Alcohol (ethanol) | CNS depressant | Opioid with alcohol: additive respiratory depression |
| Major | Other benzodiazepines (diazepam, clonazepam, lorazepam, alprazolam, temazepam) | Benzodiazepine | Opioid with benzodiazepine: risk of profound sedation, respiratory depression, coma, and death |
| Major | Other CNS depressants (opioids, benzodiazepines, sleep aids, sedating antihistamines, gabapentinoids, muscle relaxants) | CNS depressant | Tramadol with other CNS depressants: additive respiratory depression |
| Major | Other CNS depressants (opioids, benzodiazepines, sleep aids, sedating antihistamines, gabapentinoids, muscle relaxants) | CNS depressant | Opioid with other CNS depressants: additive respiratory depression |
| Major | Other gabapentinoids (gabapentin, pregabalin) | Gabapentinoid | Opioid with gabapentinoid: serious breathing difficulties |
| Major | Other serotonergic drugs (tramadol, SSRIs, SNRIs, triptans, St John's Wort, linezolid) | Serotonergic agent | Tramadol with serotonergic drugs: serotonin syndrome |
With: MAO inhibitors (phenelzine, tranylcypromine, linezolid, methylene blue) Monoamine oxidase inhibitor
MAO inhibitors impair metabolism of tramadol and potentiate its serotonergic and opioid effects.
Serotonin syndrome, respiratory depression, coma, and death.
The combination is contraindicated. Do not combine.
Basis: Tramadol HCl tablets prescribing information, Contraindications. source
With: MAO inhibitors (phenelzine, tranylcypromine, linezolid, methylene blue) Monoamine oxidase inhibitor
MAO inhibitors potentiate opioid effects and impair metabolism.
Severe unpredictable reactions including respiratory depression and death.
Do not combine.
Basis: Opioid-containing product labeling, Contraindications. source
With: Alcohol (ethanol) CNS depressant
Combined central nervous system depression.
Respiratory depression, deep sedation, and death.
Avoid alcohol during tramadol therapy.
Basis: Tramadol HCl tablets prescribing information, Warnings and Precautions. source
With: Alcohol (ethanol) CNS depressant
Both agents depress the central nervous system and breathing.
Respiratory depression, deep sedation, coma, and death.
Avoid alcohol during opioid therapy.
Basis: Opioid-containing product labeling, Warnings and Precautions. source
With: Other benzodiazepines (diazepam, clonazepam, lorazepam, alprazolam, temazepam) Benzodiazepine
Additive depression of the central nervous system and respiratory drive.
FDA requires a boxed warning on opioid-containing products describing this combination.
Avoid where possible. If used, lowest effective doses for the shortest duration with monitoring.
Basis: FDA Drug Safety Communication (2016); opioid boxed warning. source
With: Other CNS depressants (opioids, benzodiazepines, sleep aids, sedating antihistamines, gabapentinoids, muscle relaxants) CNS depressant
Tramadol depresses the central nervous system and can cause respiratory depression in its own right.
Respiratory depression, sedation, and death are possible, particularly in elderly patients and those with respiratory conditions.
Labeling advises careful monitoring and warns against use with other CNS depressants in some cases.
Basis: Tramadol HCl tablets prescribing information, Warnings and Precautions. source
With: Other CNS depressants (opioids, benzodiazepines, sleep aids, sedating antihistamines, gabapentinoids, muscle relaxants) CNS depressant
Additive central nervous system depression and slowed breathing.
Respiratory depression and overdose, particularly in older adults.
Disclose all sedating medications to the prescriber and pharmacist.
Basis: Opioid-containing product labeling, Warnings and Precautions. source
With: Other gabapentinoids (gabapentin, pregabalin) Gabapentinoid
Additive respiratory depression.
FDA warns of serious breathing difficulties and increased risk of death.
Use the lowest effective gabapentinoid dose and monitor for slowed breathing.
Basis: FDA Drug Safety Communication (2021). source
With: Other serotonergic drugs (tramadol, SSRIs, SNRIs, triptans, St John's Wort, linezolid) Serotonergic agent
Tramadol inhibits serotonin and norepinephrine reuptake. Adding other serotonergic drugs raises serotonergic tone.
Serotonin syndrome: agitation, tremor, hyperreflexia, sweating, rapid heartbeat, muscle rigidity, confusion, and potentially life-threatening hyperthermia and seizures.
Avoid where possible. If combined, use the lowest effective tramadol dose, monitor for syndrome, and watch for symptoms during dose increases.
Basis: Tramadol HCl tablets prescribing information, Warnings: Serotonin Syndrome. source
We have documented 9 interaction classes for Ultram, Tramadol in our dataset. Usually avoided, or used only with explicit prescriber oversight and close monitoring. The most serious items on this page are marked contraindicated or major.
Alcohol interacts with most of the medications on this site because it adds to sedation and slows breathing. For the specific documented risk, see the relevant entry above. The general rule from labeling is to avoid alcohol.
No. An empty result only means our curated dataset has no matching rule. A pharmacist can run a full interaction screen against every medication and supplement you take.
This site provides educational information only and does not sell, prescribe or dispense medications. Always consult a licensed healthcare provider. This page is not medical advice.