Drug interactions
Codeine + Tramadol
Severity: Major
Codeine 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
Both are opioid analgesics, so combining them adds CNS and respiratory depression without a clear benefit. Tramadol also has serotonergic activity and lowers the seizure threshold, and duplicate opioid therapy increases the risk of overdose.
What this interaction means in plain words
Codeine 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.
Codeine belongs to Musculoskeletal; Tramadol belongs to Musculoskeletal.
Why it happens
Additive opioid receptor agonism and CNS depression, with added serotonergic and seizure-threshold effects of tramadol.
What to do
Avoid concurrent use and choose a single opioid. If a switch is needed, taper one agent and monitor for sedation and respiratory depression.
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 Codeine
- Alvimopan + Codeine Contraindicated
- Codeine + Isocarboxazid Contraindicated
- Codeine + Olanzapine / samidorphan Contraindicated
- Codeine + Phenelzine Contraindicated
- Codeine + Tranylcypromine Contraindicated
- Alfentanil + Codeine Major
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 Codeine with Tramadol?
MediHelp rates the interaction as major. Codeine 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. Both are opioid analgesics, so combining them adds CNS and respiratory depression without a clear benefit. Tramadol also has serotonergic activity and lowers the seizure threshold, and duplicate opioid therapy increases the risk of overdose.
How serious is the interaction between Codeine 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 concurrent use and choose a single opioid. If a switch is needed, taper one agent and monitor for sedation and respiratory depression.
What other medicines interact with Codeine?
MediHelp also lists interactions of Codeine with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Codeine page.
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