Drug interactions
Esketamine + Tramadol
Severity: Major
Esketamine and Tramadol: major interaction.
Last updated Sources: EMA SmPC
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
Tramadol is an opioid that adds to the sedation and respiratory depression of esketamine. It also lowers the seizure threshold and has serotonergic activity.
What this interaction means in plain words
Esketamine 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.
Esketamine belongs to Central Nervous System; Tramadol belongs to Musculoskeletal.
Why it happens
Additive CNS and respiratory depression from opioid agonism plus NMDA antagonism.
What to do
Use the lowest effective doses and monitor sedation and respiratory status after esketamine; consider an alternative analgesic if risk is high.
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 Esketamine
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 Esketamine with Tramadol?
MediHelp rates the interaction as major. Esketamine 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. Tramadol is an opioid that adds to the sedation and respiratory depression of esketamine. It also lowers the seizure threshold and has serotonergic activity.
How serious is the interaction between Esketamine 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: Use the lowest effective doses and monitor sedation and respiratory status after esketamine; consider an alternative analgesic if risk is high.
What other medicines interact with Esketamine?
MediHelp also lists interactions of Esketamine with, for example, Alfentanil, Amobarbital, Belladonna and opium. The full list is on the Esketamine page.
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