Drug interactions
Butalbital + Tramadol
Severity: Major
Butalbital and Tramadol: major interaction.
Last updated Sources: US FDA label
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
Butalbital is a barbiturate that adds to the CNS and respiratory depression of opioids like tramadol. It may also induce CYP3A4, lowering tramadol exposure. The combination raises the risk of profound sedation and overdose.
What this interaction means in plain words
Butalbital and Tramadol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive CNS and respiratory depression, with possible enzyme induction.
What to do
Avoid combined use where possible, or limit doses and duration and monitor for sedation and respiratory depression. Counsel patients to avoid alcohol and other depressants.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Butalbital and Tramadol, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Tramadol
- Isocarboxazid + Tramadol Contraindicated
- Olanzapine / samidorphan + Tramadol Contraindicated
- Phenelzine + Tramadol Contraindicated
- Procarbazine + Tramadol Contraindicated
- Rasagiline + Tramadol Contraindicated
- Safinamide + Tramadol Contraindicated
Frequently asked questions
Can I take Butalbital with Tramadol?
MediHelp rates the interaction as major. Butalbital and Tramadol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Butalbital is a barbiturate that adds to the CNS and respiratory depression of opioids like tramadol. It may also induce CYP3A4, lowering tramadol exposure. The combination raises the risk of profound sedation and overdose.
How serious is the interaction between Butalbital and Tramadol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid combined use where possible, or limit doses and duration and monitor for sedation and respiratory depression. Counsel patients to avoid alcohol and other depressants.
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.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
