Drug interactions
Atazanavir + Tramadol
Severity: Moderate
Atazanavir and Tramadol: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Atazanavir inhibits CYP3A4, one of the pathways that clear tramadol, and may raise tramadol concentrations. Higher parent drug exposure may increase serotonergic effects, seizures and opioid toxicity, while CYP2D6 activation is unchanged. Boosting with ritonavir adds CYP2D6 and CYP3A4 effects.
What this interaction means in plain words
Atazanavir and Tramadol can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Atazanavir belongs to Anti Virals; Tramadol belongs to Musculoskeletal.
Why it happens
Inhibition of CYP3A4-mediated tramadol metabolism.
What to do
Monitor for sedation, respiratory depression, seizures and serotonin toxicity, and use the lowest effective tramadol dose. Reduce the dose if adverse effects appear.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Tramadol
- Isocarboxazid + Tramadol Contraindicated
- Olanzapine / samidorphan + Tramadol Contraindicated
- Phenelzine + Tramadol Contraindicated
- Procarbazine + Tramadol Contraindicated
- Rasagiline + Tramadol Contraindicated
- Safinamide + Tramadol Contraindicated
Other interactions of Atazanavir
- Alfuzosin + Atazanavir Contraindicated
- Atazanavir + Avanafil Contraindicated
- Atazanavir + Dronedarone Contraindicated
- Atazanavir + Eletriptan Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Atazanavir + Ergotamine Contraindicated
Frequently asked questions
Can I take Atazanavir with Tramadol?
MediHelp rates the interaction as moderate. Atazanavir and Tramadol can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Atazanavir inhibits CYP3A4, one of the pathways that clear tramadol, and may raise tramadol concentrations. Higher parent drug exposure may increase serotonergic effects, seizures and opioid toxicity, while CYP2D6 activation is unchanged. Boosting with ritonavir adds CYP2D6 and CYP3A4 effects.
How serious is the interaction between Atazanavir and Tramadol?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for sedation, respiratory depression, seizures and serotonin toxicity, and use the lowest effective tramadol dose. Reduce the dose if adverse effects appear.
What other medicines interact with Tramadol?
MediHelp also lists interactions of Tramadol with, for example, Isocarboxazid, Olanzapine / samidorphan, Phenelzine. The full list is on the Tramadol page.
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