Drug interactions
Fentanyl + Tramadol
Severity: Major
Fentanyl and Tramadol: major interaction.
Last updated
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 fentanyl with tramadol causes additive opioid effects including respiratory depression and sedation. Tramadol inhibits serotonin and noradrenaline reuptake, so serotonin syndrome and seizure risk are also increased.
What this interaction means in plain words
Fentanyl 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.
Fentanyl belongs to Musculoskeletal; Tramadol belongs to Musculoskeletal.
Why it happens
Additive mu-opioid agonism plus serotonergic effects of tramadol and fentanyl.
What to do
Avoid concurrent use where possible; if combined, use the lowest effective doses and monitor for sedation, respiratory depression and serotonin toxicity.
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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Other interactions of Fentanyl
- Alvimopan + Fentanyl Contraindicated
- Fentanyl + Isocarboxazid Contraindicated
- Fentanyl + Olanzapine / samidorphan Contraindicated
- Fentanyl + Phenelzine Contraindicated
- Fentanyl + Tranylcypromine Contraindicated
- Alfentanil + Fentanyl 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 Fentanyl with Tramadol?
MediHelp rates the interaction as major. Fentanyl 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 fentanyl with tramadol causes additive opioid effects including respiratory depression and sedation. Tramadol inhibits serotonin and noradrenaline reuptake, so serotonin syndrome and seizure risk are also increased.
How serious is the interaction between Fentanyl 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 where possible; if combined, use the lowest effective doses and monitor for sedation, respiratory depression and serotonin toxicity.
What other medicines interact with Fentanyl?
MediHelp also lists interactions of Fentanyl with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Fentanyl page.
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