Drug interactions
Desipramine + Tramadol
Severity: Major
Desipramine 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 drugs enhance serotonergic and noradrenergic transmission, so serotonin syndrome is possible. Tramadol and tricyclics also lower the seizure threshold and cause additive sedation. Desipramine, a CYP2D6 substrate and weak inhibitor, may also reduce formation of tramadol's active metabolite, which may lessen analgesia.
What this interaction means in plain words
Desipramine 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.
Desipramine belongs to Central Nervous System; Tramadol belongs to Musculoskeletal.
Why it happens
Additive serotonin and norepinephrine reuptake inhibition, additive seizure threshold lowering and CNS depression, plus possible CYP2D6 competition.
What to do
Avoid if possible, or use the lowest doses and monitor for serotonin toxicity (agitation, tremor, hyperthermia, clonus), seizures and inadequate analgesia. Consider a non-serotonergic analgesic.
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 Desipramine 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
Other interactions of Desipramine
- Desipramine + Disopyramide Contraindicated
- Desipramine + Dofetilide Contraindicated
- Desipramine + Ibutilide Contraindicated
- Desipramine + Isocarboxazid Contraindicated
- Desipramine + Methylene blue Contraindicated
- Desipramine + Pentamidine Contraindicated
Frequently asked questions
Can I take Desipramine with Tramadol?
MediHelp rates the interaction as major. Desipramine 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 drugs enhance serotonergic and noradrenergic transmission, so serotonin syndrome is possible. Tramadol and tricyclics also lower the seizure threshold and cause additive sedation. Desipramine, a CYP2D6 substrate and weak inhibitor, may also reduce formation of tramadol's active metabolite, which may lessen analgesia.
How serious is the interaction between Desipramine 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 doses and monitor for serotonin toxicity (agitation, tremor, hyperthermia, clonus), seizures and inadequate analgesia. Consider a non-serotonergic analgesic.
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.
