Drug interactions
Diamorphine + Tramadol
Severity: Major
Diamorphine 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
Combining tramadol with diamorphine (heroin) adds opioid respiratory and CNS depression. Tramadol may also provoke withdrawal or relapse in opioid-dependent patients and lowers seizure threshold.
What this interaction means in plain words
Diamorphine 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 mu-opioid agonism and CNS depression, with tramadol's added serotonergic and noradrenergic effects.
What to do
Avoid concurrent use; use one opioid with specialist guidance. If both are given, monitor for sedation, respiratory depression and withdrawal.
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
Frequently asked questions
Can I take Diamorphine with Tramadol?
MediHelp rates the interaction as major. Diamorphine 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. Combining tramadol with diamorphine (heroin) adds opioid respiratory and CNS depression. Tramadol may also provoke withdrawal or relapse in opioid-dependent patients and lowers seizure threshold.
How serious is the interaction between Diamorphine 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; use one opioid with specialist guidance. If both are given, monitor for sedation, respiratory depression and withdrawal.
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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