Tramacet Interactions with Other Medications

Other Medications

Because Tramacet can interact poorly with several other drugs or medications, it is important to inform your pharmacist and physician about all medications you are currently taking, including any herbal or over-the-counter medicines.

Be aware that eating cabbage while taking Tramacet can cause a drug interaction. This occurs because the body uses the liver to break down some drugs, including paracetamol or acetaminophen. Cabbage may increase the speed at which the liver breaks down the paracetamol part of Tramacet, which can reduce this painkiller's effectiveness.

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Do not take any other medications containing tramadol or paracetamol during the time you're taking Tramacet, because you can easily exceed the maximum daily safe levels for these drugs. Do not use other opioids, such as oxycodone, morphine or codeine while taking Tramacet.

Avoid taking this medication if you currently use digoxin or quinidine. Do not take Tramacet while using MAOI antidepressants, such as moclobemide, tranylcypromine, isocarboxazid and phenelzine, or if you have taken an MAOI within the last 14 days.

Taking Tramacet in conjunction with sleeping pills (zopiclone), muscle relaxants (baclofen), barbiturates (amobarbital or phenobarbital), sedatives (diazepam and lorazepam), tricyclic antidepressants (amitriptyline), antipsychotics (haloperidol), benzodiazepines (temazepam and diazepam), antihistamines (hydroxyzine and chlorphenamine), or other opioids (tramadol and codeine), can increase some of the side effects, such as feelings of sedation or drowsiness.

Patients may experience an increased risk of seizures or convulsions if they take Tramacet, especially in higher doses, in conjunction with any of the following medications: mefloquine, bupropion, promethazine, muscle relaxers (cyclobenzaprine), opioids (codeine, oxycodone, morphine), SSRI antidepressants (sertraline, fluoxetine, citalopram, paroxetine, zimelidine, escitalopram, dapoxetine, mesembrine), neuroleptics (olanzapine, quetiapine, haloperidol, resperidone), tricyclic antidepressants (TCA) (imipramine, amitriptyline, nortriptyline), antipsychotic medications (olanzapine, quetiapine, resperidone, haloperidol), and MAOI antidepressants (isocarboxazid, phenelzine, tranylcypromine, nialamide, moclobemide, rasagiline, pirlindole, selegiline, isoniazid, toloxatone).

Because tramadol helps enhance the effects of serotonin in the human body, there is a possibility of suffering a rare and life threatening reaction known as "serotonin syndrome," whereby too much serotonin is available in the body, creating a form of poisoning. Serotonin syndrome can occur because of a reaction between drugs or overdosing on a particular drug.

Among the drugs which can react with Tramacet to cause serotonin syndrome are triptans used for migraines (sumatriptan), MAOI inhibitors (tranylcypromine, isocarboxazid, phenelzine), the drug mirtazapine, serotonin noradrenaline reuptake inhibitors (SNRIs) (duloxetine, venlafaxine, milnacipran, sibutramine, bicifadine, desvenlafaxine, levomilnacipran), the drug dapoxetine, SSRI antidepressants (paroxetine, fluoxetine, citalopram, fluvoxamine, sertraline, escitalopram), tricyclic antidepressants (amitriptyline) and the herb St. John's wort (Hypericum perforatum).

Symptoms of serotonin syndrome can include high blood pressure, rigidity of the muscles, agitation, high fever, tremors or muscle spasms, sweating, difficulty moving, an increase in heart rate, dilated pupils, delirium and shivering. If you experience any of these symptoms after taking Tramacet, contact your doctor or nearest emergency room immediately.

When taking Tramacet with ondansetron or carbamazepine, you may find that the painkilling abilities of Tramacet are reduced. The drugs domperidone and metoclopramide can increase paracetamol's absorption from the intestinal tract. Taking cholestyramine and Tramacet at the same time can reduce paracetamol's absorption in the intestinal tract. If you take anticoagulant medications such as warfarin and Tramacet together for a long period of time, the effects of the anticoagulants may be increased, and a physician should test for blood clotting time.

Other medications that should be used with caution while taking Tramacet include the following: zuclopenthixol, thioridazine, penfluridol, fluphenazine, acetophenazine, thiothixene, pentazocine, hydrocodone, amoxapine, acenocoumarol, perphenazine, hydroxytryptophan, amphetamine, carbamazepine, trazodone, imatinib, bromperidol, fosphenytoin, trifluoperazine, pimozide, iproniazid, brompheniramine, ketamine, buspirone, lixisenatide, triflupromazine, piperaquine, linezolid, carbinoxamine, perampanel, trimeprazine, pipotiazine, lithium, chlorpheniramine, phenytoin, trimipramine, pixantrone, lofepramine, chlorpromazine, zidovudine, valproic acid, primidone, lorcaserin, chlorprothixene, vilazodone, procarbazine, meclizine, clarithromycin, vortioxetine, prochlorperazine, melperone, flupenthixol, clomipramine, zolmitriptan, promazine, meperidine, fentanyl, clorgyline, propiomazine, mesoridazine, clovoxamine, thiethylperazine, methadone, cobicistat, pargyline, femoxetine, cocaine, propoxyphene, nefazodone, crizotinib, protriptyline, methotrimeprazine, dabrafenib, methylene blue, remoxipride, eslicarbazepine acetate, desipramine, mitotane, dothiepin, rizatriptan, dextroamphetamine, mirabegron, ethopropazine, dextromethorphan, molindone, eletriptan, naratriptan and doxepin.

Discuss any potential interactions with you healthcare professional. Depending on circumstances, your physician may choose one of the following courses of action: exchange one medication you are taking for another with fewer interactive effects, stop one of the medications you are taking, change dosage amounts of one or more of your current medications or change nothing at the moment and monitor the situation.