Drug interactions
Cobicistat + Tramadol
Severity: Major
Cobicistat 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
Cobicistat inhibits CYP3A4 and CYP2D6, both of which metabolize tramadol. Tramadol levels may rise, increasing the risk of opioid toxicity, seizures and serotonin syndrome, while formation of the active metabolite O-desmethyltramadol may be reduced, altering analgesia.
What this interaction means in plain words
Cobicistat 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.
Cobicistat belongs to Miscellaneous; Tramadol belongs to Musculoskeletal.
Why it happens
Inhibition of CYP3A4 and CYP2D6 by cobicistat reduces tramadol clearance and alters its metabolite formation.
What to do
Start tramadol at a lower dose and titrate carefully, monitoring for sedation, respiratory depression, seizures and serotonin toxicity. Consider an alternative analgesic if response is inadequate or adverse effects occur.
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 Cobicistat
- Alfuzosin + Cobicistat Contraindicated
- Apalutamide + Cobicistat Contraindicated
- Cobicistat + Colchicine Contraindicated
- Cobicistat + Dronedarone Contraindicated
- Cobicistat + Eletriptan Contraindicated
- Cobicistat + Eplerenone Contraindicated
Frequently asked questions
Can I take Cobicistat with Tramadol?
MediHelp rates the interaction as major. Cobicistat 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. Cobicistat inhibits CYP3A4 and CYP2D6, both of which metabolize tramadol. Tramadol levels may rise, increasing the risk of opioid toxicity, seizures and serotonin syndrome, while formation of the active metabolite O-desmethyltramadol may be reduced, altering analgesia.
How serious is the interaction between Cobicistat 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: Start tramadol at a lower dose and titrate carefully, monitoring for sedation, respiratory depression, seizures and serotonin toxicity. Consider an alternative analgesic if response is inadequate or adverse effects occur.
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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