Drug interactions
Duloxetine + Tramadol
Severity: Major
Duloxetine 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
Duloxetine inhibits CYP2D6 and is a serotonin-norepinephrine reuptake inhibitor. It can raise parent tramadol levels and reduce the active metabolite, while increasing the risk of serotonin syndrome and seizures.
What this interaction means in plain words
Duloxetine 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.
Duloxetine belongs to Central Nervous System; Tramadol belongs to Musculoskeletal.
Why it happens
CYP2D6 inhibition by duloxetine plus additive serotonergic effects with tramadol.
What to do
Avoid if possible and choose a different analgesic. If combined, use the lowest tramadol dose and monitor for serotonin toxicity, seizures and inadequate pain relief.
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 Duloxetine
- Duloxetine + Isocarboxazid Contraindicated
- Duloxetine + Linezolid Contraindicated
- Duloxetine + Methylene blue Contraindicated
- Duloxetine + Phenelzine Contraindicated
- Duloxetine + Procarbazine Contraindicated
- Duloxetine + Rasagiline Contraindicated
Frequently asked questions
Can I take Duloxetine with Tramadol?
MediHelp rates the interaction as major. Duloxetine 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. Duloxetine inhibits CYP2D6 and is a serotonin-norepinephrine reuptake inhibitor. It can raise parent tramadol levels and reduce the active metabolite, while increasing the risk of serotonin syndrome and seizures.
How serious is the interaction between Duloxetine 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 and choose a different analgesic. If combined, use the lowest tramadol dose and monitor for serotonin toxicity, seizures and inadequate pain relief.
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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