Drug interactions
Itraconazole + Tramadol
Severity: Moderate
Itraconazole and Tramadol: moderate 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
Itraconazole strongly inhibits CYP3A4, which is a route for tramadol N-demethylation, so tramadol exposure may rise. Higher parent drug levels may increase the risk of adverse effects such as seizures, serotonin syndrome and sedation.
What this interaction means in plain words
Itraconazole and Tramadol can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Itraconazole belongs to Anti Fungals; Tramadol belongs to Musculoskeletal.
Why it happens
Inhibition of CYP3A4-mediated tramadol metabolism, increasing tramadol concentrations.
What to do
Monitor for sedation, respiratory depression and serotonergic or seizure effects, and reduce the tramadol dose if needed. Reassess when itraconazole is started or stopped.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole Contraindicated
Frequently asked questions
Can I take Itraconazole with Tramadol?
MediHelp rates the interaction as moderate. Itraconazole and Tramadol can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Itraconazole strongly inhibits CYP3A4, which is a route for tramadol N-demethylation, so tramadol exposure may rise. Higher parent drug levels may increase the risk of adverse effects such as seizures, serotonin syndrome and sedation.
How serious is the interaction between Itraconazole and Tramadol?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for sedation, respiratory depression and serotonergic or seizure effects, and reduce the tramadol dose if needed. Reassess when itraconazole is started or stopped.
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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