Drug interactions
Bosentan + Tramadol
Severity: Moderate
Bosentan 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
Bosentan induces CYP3A4 and CYP2C9, which can increase tramadol N-demethylation and lower exposure to the parent drug. Analgesic effect may be reduced and the balance of parent drug to active metabolite may change, so the clinical effect is hard to predict.
What this interaction means in plain words
Bosentan 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.
Bosentan belongs to Miscellaneous; Tramadol belongs to Musculoskeletal.
Why it happens
Induction of CYP3A4 (and other enzymes) by bosentan, increasing tramadol clearance.
What to do
Monitor pain control and adjust the tramadol dose as needed, or consider an alternative analgesic if response is poor. Reassess if bosentan is started or stopped.
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 Bosentan
- Bosentan + Cyclosporin Contraindicated
- Bosentan + Glibenclamide Contraindicated
- Bosentan + Glyburide-metformin Contraindicated
- Bosentan + Lonafarnib Contraindicated
- Bosentan + Sparsentan Contraindicated
- Artemether / lumefantrine + Bosentan Major
Frequently asked questions
Can I take Bosentan with Tramadol?
MediHelp rates the interaction as moderate. Bosentan 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. Bosentan induces CYP3A4 and CYP2C9, which can increase tramadol N-demethylation and lower exposure to the parent drug. Analgesic effect may be reduced and the balance of parent drug to active metabolite may change, so the clinical effect is hard to predict.
How serious is the interaction between Bosentan 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 pain control and adjust the tramadol dose as needed, or consider an alternative analgesic if response is poor. Reassess if bosentan is started or stopped.
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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