Drug interactions
Terbinafine + Tramadol
Severity: Moderate
Terbinafine 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
Terbinafine is a strong CYP2D6 inhibitor and can reduce conversion of tramadol to its active opioid metabolite O-desmethyltramadol. This may weaken analgesia while parent tramadol levels rise, increasing serotonergic and seizure risk.
What this interaction means in plain words
Terbinafine 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.
Terbinafine belongs to Anti Fungals; Tramadol belongs to Musculoskeletal.
Why it happens
Inhibition of CYP2D6-mediated activation of tramadol.
What to do
Monitor pain control and for serotonergic or seizure effects during terbinafine therapy. Consider a different analgesic if tramadol becomes ineffective.
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 Terbinafine
- Terbinafine + Thioridazine Contraindicated
- Desipramine + Terbinafine Major
- Eliglustat + Terbinafine Major
- Flecainide + Terbinafine Major
- Imipramine + Terbinafine Major
- Maprotiline + Terbinafine Major
Frequently asked questions
Can I take Terbinafine with Tramadol?
MediHelp rates the interaction as moderate. Terbinafine 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. Terbinafine is a strong CYP2D6 inhibitor and can reduce conversion of tramadol to its active opioid metabolite O-desmethyltramadol. This may weaken analgesia while parent tramadol levels rise, increasing serotonergic and seizure risk.
How serious is the interaction between Terbinafine 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 pain control and for serotonergic or seizure effects during terbinafine therapy. Consider a different analgesic if tramadol becomes ineffective.
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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