Drug interactions
Remifentanil + Tramadol
Severity: Major
Remifentanil 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
Both drugs are opioid agonists and together cause additive sedation and respiratory depression. Tramadol also inhibits serotonin and norepinephrine reuptake, which adds a serotonin syndrome risk, and it can lower the seizure threshold. Perioperative or procedural use can make the effect more pronounced.
What this interaction means in plain words
Remifentanil 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.
Remifentanil belongs to Musculoskeletal; Tramadol belongs to Musculoskeletal.
Why it happens
Additive mu-opioid CNS and respiratory depression, with tramadol contributing serotonergic and noradrenergic reuptake inhibition.
What to do
Use the lowest effective doses, reduce the dose of one agent where possible, and monitor respiratory rate, sedation and oxygenation continuously. Watch for serotonin toxicity and seizures.
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 Remifentanil
- Alvimopan + Remifentanil Contraindicated
- Isocarboxazid + Remifentanil Contraindicated
- Olanzapine / samidorphan + Remifentanil Contraindicated
- Phenelzine + Remifentanil Contraindicated
- Benzhydrocodone / acetaminophen + Remifentanil Major
- Brexanolone + Remifentanil 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 Remifentanil with Tramadol?
MediHelp rates the interaction as major. Remifentanil 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. Both drugs are opioid agonists and together cause additive sedation and respiratory depression. Tramadol also inhibits serotonin and norepinephrine reuptake, which adds a serotonin syndrome risk, and it can lower the seizure threshold. Perioperative or procedural use can make the effect more pronounced.
How serious is the interaction between Remifentanil 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, reduce the dose of one agent where possible, and monitor respiratory rate, sedation and oxygenation continuously. Watch for serotonin toxicity and seizures.
What other medicines interact with Remifentanil?
MediHelp also lists interactions of Remifentanil with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Remifentanil page.
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