Drug interactions
Promethazine + Tramadol
Severity: Major
Promethazine 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
Promethazine and tramadol both depress the CNS, so the combination increases sedation and the risk of respiratory depression. Both drugs can also lower the seizure threshold.
What this interaction means in plain words
Promethazine 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.
Promethazine belongs to Respiratory; Tramadol belongs to Musculoskeletal.
Why it happens
Additive CNS and respiratory depression, with additive lowering of seizure threshold.
What to do
Use the lowest effective doses and monitor sedation and respiratory rate. Avoid in patients with seizure history and avoid other CNS depressants.
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 Promethazine
- Ibutilide + Promethazine Contraindicated
- Pimozide + Promethazine Contraindicated
- Promethazine + Thioridazine Contraindicated
- Alfentanil + Promethazine Major
- Amiodarone + Promethazine Major
- Amisulpride + Promethazine 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 Promethazine with Tramadol?
MediHelp rates the interaction as major. Promethazine 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. Promethazine and tramadol both depress the CNS, so the combination increases sedation and the risk of respiratory depression. Both drugs can also lower the seizure threshold.
How serious is the interaction between Promethazine 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 rate. Avoid in patients with seizure history and avoid other CNS depressants.
What other medicines interact with Promethazine?
MediHelp also lists interactions of Promethazine with, for example, Ibutilide, Pimozide, Thioridazine. The full list is on the Promethazine page.
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