Drug interactions
Clomipramine + Tramadol
Severity: Major
Clomipramine 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
Clomipramine strongly inhibits serotonin reuptake, so combined use with tramadol raises the risk of serotonin syndrome and seizures. Clomipramine also inhibits CYP2D6, which may reduce conversion of tramadol to its active opioid metabolite, and both drugs add to sedation.
What this interaction means in plain words
Clomipramine 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.
Clomipramine belongs to Central Nervous System; Tramadol belongs to Musculoskeletal.
Why it happens
Additive serotonergic effects and seizure threshold lowering, plus CYP2D6 inhibition reducing tramadol activation.
What to do
Avoid if possible, or use the lowest tramadol dose and monitor for serotonin syndrome, seizures and loss of analgesia. Choose a non-serotonergic analgesic where feasible.
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?
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References
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 Clomipramine
- Arsenic trioxide + Clomipramine Contraindicated
- Clomipramine + Dofetilide Contraindicated
- Clomipramine + Droperidol Contraindicated
- Clomipramine + Isocarboxazid Contraindicated
- Clomipramine + Methylene blue Contraindicated
- Clomipramine + Pentamidine Contraindicated
Frequently asked questions
Can I take Clomipramine with Tramadol?
MediHelp rates the interaction as major. Clomipramine 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. Clomipramine strongly inhibits serotonin reuptake, so combined use with tramadol raises the risk of serotonin syndrome and seizures. Clomipramine also inhibits CYP2D6, which may reduce conversion of tramadol to its active opioid metabolite, and both drugs add to sedation.
How serious is the interaction between Clomipramine 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 if possible, or use the lowest tramadol dose and monitor for serotonin syndrome, seizures and loss of analgesia. Choose a non-serotonergic analgesic where feasible.
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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