Drug interactions
Hydromorphone + Tramadol
Severity: Major
Hydromorphone 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 tramadol with a full opioid agonist adds sedation and respiratory depression, and tramadol also lowers seizure threshold and has serotonergic activity. In opioid-dependent patients, tramadol's partial effects may unpredictably alter analgesia or withdrawal.
What this interaction means in plain words
Hydromorphone 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.
Hydromorphone belongs to Musculoskeletal; Tramadol belongs to Musculoskeletal.
Why it happens
Additive mu-opioid CNS depression with tramadol's additional serotonin and norepinephrine reuptake inhibition.
What to do
Avoid routine combination and use one opioid where possible. If both are needed, use the lowest doses and monitor sedation, respiratory rate and seizure or serotonin syndrome signs.
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 Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
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 Hydromorphone with Tramadol?
MediHelp rates the interaction as major. Hydromorphone 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 a full opioid agonist adds sedation and respiratory depression, and tramadol also lowers seizure threshold and has serotonergic activity. In opioid-dependent patients, tramadol's partial effects may unpredictably alter analgesia or withdrawal.
How serious is the interaction between Hydromorphone 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 routine combination and use one opioid where possible. If both are needed, use the lowest doses and monitor sedation, respiratory rate and seizure or serotonin syndrome signs.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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