Drug interactions
Tramadol + Voriconazole
Severity: Moderate
Tramadol and Voriconazole: 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
Voriconazole inhibits CYP3A4 (and CYP2C19), which can raise tramadol concentrations through reduced N-demethylation. Higher exposure may increase opioid, serotonergic and seizure risks, and respiratory depression.
What this interaction means in plain words
Tramadol and Voriconazole 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.
Tramadol belongs to Musculoskeletal; Voriconazole belongs to Anti Fungals.
Why it happens
Voriconazole inhibits CYP3A4-mediated metabolism of tramadol, increasing parent drug exposure.
What to do
Monitor for sedation, respiratory depression and serotonin toxicity, and reduce the tramadol dose if needed. Reassess when voriconazole is 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 Voriconazole
- Avanafil + Voriconazole Contraindicated
- Butabarbital + Voriconazole Contraindicated
- Carbamazepine + Voriconazole Contraindicated
- Conivaptan + Voriconazole Contraindicated
- Dihydroergotamine intranasal + Voriconazole Contraindicated
- Dihydroergotamine + Voriconazole Contraindicated
Frequently asked questions
Can I take Tramadol with Voriconazole?
MediHelp rates the interaction as moderate. Tramadol and Voriconazole 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. Voriconazole inhibits CYP3A4 (and CYP2C19), which can raise tramadol concentrations through reduced N-demethylation. Higher exposure may increase opioid, serotonergic and seizure risks, and respiratory depression.
How serious is the interaction between Tramadol and Voriconazole?
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 serotonin toxicity, and reduce the tramadol dose if needed. Reassess when voriconazole is 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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