Ultracet

Overview

acetaminophen

centrally-acting analgesic/antipyretic

• CYP2E1 substrate
• UGT1A1 substrate
• UGT2B15 substrate
• affected by altered gastrointestinal motility
• methemoglobinemia

tramadol

opioid

• CYP2D6 substrate
• CYP3A4 substrate
• antidiuretic hormone effects
• CNS depression
• decreases gastrointestinal motility
• hypoglycemic effects
• hyponatremia
• hypotensive effects
• lowers seizure threshold
• opioid agonist
• potentiates neuromuscular blockade
• prolongs QT interval (known)
• serotonergic effects
• urinary retention

• consider prescribing naloxone, esp. w/ concomitant CNS depressant use
• add MAO inhibitor to Interaction Check if recent (14 days) use

Contraindicated

• cisapride
Ultracet (tramadol/ acetaminophen)

+

cisapride

1 interaction

Contraindicated

tramadol + cisapride

contraindicated: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. cisapride efficacy (additive effects; antagonistic effects)

• domperidone
Ultracet (tramadol/ acetaminophen)

+

domperidone

1 interaction

Contraindicated

tramadol + domperidone

contraindicated: combo may incr. risk of QT prolongation, cardiac arrhythmias, profound CNS and resp. depression, psychomotor impairment; may decr. domperidone efficacy (additive effects; antagonistic effects)

• dronedarone
Ultracet (tramadol/ acetaminophen)

+

dronedarone

1 interaction

Contraindicated

tramadol + dronedarone

contraindicated: combo may incr. tramadol, alter active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite; additive effects)

• fluconazole
Ultracet (tramadol/ acetaminophen)

+

fluconazole

1 interaction

Contraindicated

tramadol + fluconazole

contraindicated: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• isocarboxazid
Ultracet (tramadol/ acetaminophen)

+

isocarboxazid

1 interaction

Contraindicated

tramadol + isocarboxazid

contraindicated w/in 14 days of isocarboxazid use: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• levoketoconazole
Ultracet (tramadol/ acetaminophen)

+

levoketoconazole

1 interaction

Contraindicated

tramadol + levoketoconazole

contraindicated: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, additive effects)

• lidocaine topical
Ultracet (tramadol/ acetaminophen)

+

lidocaine topical

2 interactions

Contraindicated

acetaminophen + lidocaine topical

contraindicated if <1 yo; otherwise, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of methemoglobinemia (additive effects)

Caution Advised

tramadol + lidocaine topical

caution advised: combo may incr. risk of seizures (additive effects)

• linezolid
Ultracet (tramadol/ acetaminophen)

+

linezolid

1 interaction

Contraindicated

tramadol + linezolid

contraindicated w/in 14 days of linezolid use; hold tramadol if urgent use; monitor resp. rate, sodium, serotonin syndrome sx x2wk after tramadol D/C or 24h after last linezolid dose: combo may incr. risk of resp. depression, serotonin syndrome, seizures, severe hyponatremia (additive effects, linezolid reversibly inhibits monoamine oxidase)

• methylene blue injection
Ultracet (tramadol/ acetaminophen)

+

methylene blue injection

1 interaction

Contraindicated

tramadol + methylene blue injection

contraindicated w/in 14 days of methylene blue use; hold tramadol if emergency use; monitor resp. rate, BP, serotonin syndrome sx up to 4h after last methylene blue dose; may resume tramadol 72h after last methylene blue dose: combo may incr. risk of resp. depression, serotonin syndrome, severe hypotension, incl. orthostasis, syncope (additive effects, methylene blue reversibly inhibits monoamine oxidase)

• methylene blue oral
Ultracet (tramadol/ acetaminophen)

+

methylene blue oral

1 interaction

Contraindicated

tramadol + methylene blue oral

contraindicated w/in 14 days of methylene blue use: combo may incr. risk of resp. depression, serotonin syndrome (additive effects, methylene blue reversibly inhibits monoamine oxidase)

• naltrexone
Ultracet (tramadol/ acetaminophen)

+

naltrexone

1 interaction

Contraindicated

tramadol + naltrexone

contraindicated; D/C tramadol at least 7-10 days before naltrexone start: combo may decr. tramadol efficacy, precipitate withdrawal in opioid dependent pts (antagonistic effects)

• phenelzine
Ultracet (tramadol/ acetaminophen)

+

phenelzine

1 interaction

Contraindicated

tramadol + phenelzine

contraindicated w/in 14 days of phenelzine use: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• pimozide
Ultracet (tramadol/ acetaminophen)

+

pimozide

1 interaction

Contraindicated

tramadol + pimozide

contraindicated: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, QT prolongation, cardiac arrhythmias, severe constipation, paralytic ileus, urinary retention (additive effects)

• posaconazole
Ultracet (tramadol/ acetaminophen)

+

posaconazole

1 interaction

Contraindicated

tramadol + posaconazole

contraindicated: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• potassium chloride
Ultracet (tramadol/ acetaminophen)

+

potassium chloride

1 interaction

Contraindicated

tramadol + potassium chloride

contraindicated w/ solid potassium formulations; consider alternative, incl. liquid potassium formulations: combo may incr. risk of GI ulcerative, stenotic lesions (GI transit delayed, increased local exposure to high potassium concentration)

• potassium citrate
Ultracet (tramadol/ acetaminophen)

+

potassium citrate

1 interaction

Contraindicated

tramadol + potassium citrate

contraindicated w/ solid potassium formulations; consider alternative, incl. liquid potassium formulations: combo may incr. risk of GI ulcerative, stenotic lesions (GI transit delayed, increased local exposure to high potassium concentration)

• prilocaine topical
Ultracet (tramadol/ acetaminophen)

+

prilocaine topical

1 interaction

Contraindicated

acetaminophen + prilocaine topical

contraindicated if <1 yo; otherwise, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of methemoglobinemia (additive effects)

• procarbazine
Ultracet (tramadol/ acetaminophen)

+

procarbazine

1 interaction

Contraindicated

tramadol + procarbazine

contraindicated w/in 14 days of procarbazine use: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, severe hypotension, incl. orthostasis, syncope (additive effects, procarbazine inhibits monoamine oxidase)

• quinidine (CYP2D6 inhibitor)
Ultracet (tramadol/ acetaminophen)

+

quinidine (CYP2D6 inhibitor)

1 interaction

Contraindicated

tramadol + quinidine (CYP2D6 inhibitor)

contraindicated: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• rasagiline
Ultracet (tramadol/ acetaminophen)

+

rasagiline

1 interaction

Contraindicated

tramadol + rasagiline

contraindicated w/in 14 days of rasagiline use: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension, incl. orthostasis, syncope (additive effects)

• safinamide
Ultracet (tramadol/ acetaminophen)

+

safinamide

1 interaction

Contraindicated

tramadol + safinamide

contraindicated w/in 14 days of safinamide use: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension, incl. orthostasis, syncope (additive effects)

• samidorphan
Ultracet (tramadol/ acetaminophen)

+

samidorphan

1 interaction

Contraindicated

tramadol + samidorphan

contraindicated; D/C tramadol at least 7 days before samidorphan start; D/C samidorphan at least 5 days before non-urgent tramadol use: combo may decr. tramadol efficacy, precipitate severe withdrawal in opioid dependent pts (antagonistic effects)

• selegiline
Ultracet (tramadol/ acetaminophen)

+

selegiline

1 interaction

Contraindicated

tramadol + selegiline

contraindicated w/in 14 days of selegiline use: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension, incl. orthostasis, syncope (additive effects)

• selegiline transdermal
Ultracet (tramadol/ acetaminophen)

+

selegiline transdermal

1 interaction

Contraindicated

tramadol + selegiline transdermal

contraindicated w/in 14 days of selegiline use: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• thioridazine
Ultracet (tramadol/ acetaminophen)

+

thioridazine

1 interaction

Contraindicated

tramadol + thioridazine

contraindicated: combo may incr. tramadol levels, risk of QT prolongation, cardiac arrhythmias, profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, severe constipation, paralytic ileus, urinary retention, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• tranylcypromine
Ultracet (tramadol/ acetaminophen)

+

tranylcypromine

1 interaction

Contraindicated

tramadol + tranylcypromine

contraindicated w/in 14 days of tranylcypromine use: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• yohimbe
Ultracet (tramadol/ acetaminophen)

+

yohimbe

1 interaction

Contraindicated

tramadol + yohimbe

contraindicated w/in 14 days of yohimbe use: combo may incr. risk of resp. depression, serotonin syndrome, severe hypotension, incl. orthostasis, syncope (additive effects, yohimbe inhibits monoamine oxidase)

Avoid/Use Alternative

• 5-HTP
Ultracet (tramadol/ acetaminophen)

+

5-HTP

1 interaction

Avoid/Use Alternative

tramadol + 5-HTP

use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)

• abiraterone acetate
Ultracet (tramadol/ acetaminophen)

+

abiraterone acetate

1 interaction

Avoid/Use Alternative

tramadol + abiraterone acetate

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• adagrasib
Ultracet (tramadol/ acetaminophen)

+

adagrasib

1 interaction

Avoid/Use Alternative

tramadol + adagrasib

consider alternative: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, additive effects, altered active metabolite production)

• aldesleukin
Ultracet (tramadol/ acetaminophen)

+

aldesleukin

1 interaction

Avoid/Use Alternative

tramadol + aldesleukin

avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe or life-threatening hypotension (incl. orthostasis, syncope), seizures (additive effects)

• alfentanil
Ultracet (tramadol/ acetaminophen)

+

alfentanil

1 interaction

Avoid/Use Alternative

tramadol + alfentanil

use alternative or monitor BP, resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus (additive effects)

• almotriptan
Ultracet (tramadol/ acetaminophen)

+

almotriptan

1 interaction

Avoid/Use Alternative

tramadol + almotriptan

use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)

• alprazolam
Ultracet (tramadol/ acetaminophen)

+

alprazolam

1 interaction

Avoid/Use Alternative

tramadol + alprazolam

use alternative or monitor BP, resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• amifampridine
Ultracet (tramadol/ acetaminophen)

+

amifampridine

1 interaction

Avoid/Use Alternative

tramadol + amifampridine

consider alternative: combo may incr. risk of seizures (additive effects)

• amiodarone
Ultracet (tramadol/ acetaminophen)

+

amiodarone

1 interaction

Avoid/Use Alternative

tramadol + amiodarone

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• amitriptyline
Ultracet (tramadol/ acetaminophen)

+

amitriptyline

1 interaction

Avoid/Use Alternative

tramadol + amitriptyline

use alternative or monitor resp. rate, ECG, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• amoxapine
Ultracet (tramadol/ acetaminophen)

+

amoxapine

1 interaction

Avoid/Use Alternative

tramadol + amoxapine

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• amphetamine
Ultracet (tramadol/ acetaminophen)

+

amphetamine

1 interaction

Avoid/Use Alternative

tramadol + amphetamine

use alternative or decr. amphetamine start dose; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome, seizures (additive effects)

• anagrelide
Ultracet (tramadol/ acetaminophen)

+

anagrelide

1 interaction

Avoid/Use Alternative

tramadol + anagrelide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• apalutamide
Ultracet (tramadol/ acetaminophen)

+

apalutamide

1 interaction

Avoid/Use Alternative

tramadol + apalutamide

use alternative or monitor withdrawal sx, ECG: combo may decr. tramadol levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias, seizures (hepatic metab. induced; additive effects)

• apomorphine
Ultracet (tramadol/ acetaminophen)

+

apomorphine

1 interaction

Avoid/Use Alternative

tramadol + apomorphine

use alternative or monitor resp. rate, ECG, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• aprepitant
Ultracet (tramadol/ acetaminophen)

+

aprepitant

1 interaction

Avoid/Use Alternative

tramadol + aprepitant

if aprepitant 3-day regimen, use alternative or monitor resp. rate, ECG, consider decr. tramadol dose; aprepitant single dose-regimen OK: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• armodafinil
Ultracet (tramadol/ acetaminophen)

+

armodafinil

1 interaction

Avoid/Use Alternative

tramadol + armodafinil

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• arsenic trioxide
Ultracet (tramadol/ acetaminophen)

+

arsenic trioxide

1 interaction

Avoid/Use Alternative

tramadol + arsenic trioxide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• artemether/lumefantrine
Ultracet (tramadol/ acetaminophen)

+

artemether/ lumefantrine

1 interaction

Avoid/Use Alternative

tramadol + artemether/ lumefantrine

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. or decr. tramadol levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy; may decr. active metabolite levels, efficacy (hepatic metab. inhibited by lumefantrine, decr. conversion to active metabolite; additive effects; hepatic metab. induced by artemether)

• asenapine
Ultracet (tramadol/ acetaminophen)

+

asenapine

1 interaction

Avoid/Use Alternative

tramadol + asenapine

use alternative or monitor resp. rate, ECG, BP, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• atazanavir
Ultracet (tramadol/ acetaminophen)

+

atazanavir

2 interactions

Avoid/Use Alternative

tramadol + atazanavir

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

Monitor/Modify Tx

acetaminophen + atazanavir

consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)

• avacopan
Ultracet (tramadol/ acetaminophen)

+

avacopan

1 interaction

Avoid/Use Alternative

tramadol + avacopan

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• azithromycin
Ultracet (tramadol/ acetaminophen)

+

azithromycin

1 interaction

Avoid/Use Alternative

tramadol + azithromycin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• baclofen intrathecal
Ultracet (tramadol/ acetaminophen)

+

baclofen intrathecal

1 interaction

Avoid/Use Alternative

tramadol + baclofen intrathecal

use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures (additive effects)

• bedaquiline
Ultracet (tramadol/ acetaminophen)

+

bedaquiline

1 interaction

Avoid/Use Alternative

tramadol + bedaquiline

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• belzutifan
Ultracet (tramadol/ acetaminophen)

+

belzutifan

1 interaction

Avoid/Use Alternative

tramadol + belzutifan

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• benztropine
Ultracet (tramadol/ acetaminophen)

+

benztropine

1 interaction

Avoid/Use Alternative

tramadol + benztropine

consider alternative: combo may incr. risk of severe constipation, paralytic ileus (incl. life-threatening), urinary retention (additive effects)

• berberine
Ultracet (tramadol/ acetaminophen)

+

berberine

1 interaction

Avoid/Use Alternative

tramadol + berberine

use alternative or monitor resp. rate, ECG, BP, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• berotralstat
Ultracet (tramadol/ acetaminophen)

+

berotralstat

1 interaction

Avoid/Use Alternative

tramadol + berotralstat

use alternative or monitor resp. rate, ECG, withdrawal sx; consider tramadol dose adjustment: combo may incr. tramadol, alter active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite, additive effects)

• bexarotene
Ultracet (tramadol/ acetaminophen)

+

bexarotene

1 interaction

Avoid/Use Alternative

tramadol + bexarotene

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• bosentan
Ultracet (tramadol/ acetaminophen)

+

bosentan

1 interaction

Avoid/Use Alternative

tramadol + bosentan

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• brigatinib
Ultracet (tramadol/ acetaminophen)

+

brigatinib

1 interaction

Avoid/Use Alternative

tramadol + brigatinib

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• bromocriptine
Ultracet (tramadol/ acetaminophen)

+

bromocriptine

1 interaction

Avoid/Use Alternative

tramadol + bromocriptine

use alternative or monitor resp. rate, BP, glucose (type 2 diabetes mellitus pts), serotonin syndrome sx, especially during initiation/titration, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypoglycemia, serotonin syndrome, severe hypotension, incl. orthostasis, syncope (additive effects)

• buprenorphine
Ultracet (tramadol/ acetaminophen)

+

buprenorphine

1 interaction

Avoid/Use Alternative

tramadol + buprenorphine

use alternative or monitor withdrawal sx, resp. rate, ECG, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol efficacy, precipitate withdrawal in opioid dependent pts; may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation, paralytic ileus (antagonistic effects; additive effects)

• bupropion
Ultracet (tramadol/ acetaminophen)

+

bupropion

1 interaction

Avoid/Use Alternative

tramadol + bupropion

use alternative or monitor resp. rate, ECG, withdrawal sx; consider lower bupropion doses: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• buspirone
Ultracet (tramadol/ acetaminophen)

+

buspirone

1 interaction

Avoid/Use Alternative

tramadol + buspirone

use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)

• butalbital
Ultracet (tramadol/ acetaminophen)

+

butalbital

2 interactions

Avoid/Use Alternative

acetaminophen + butalbital

use alternative or limit acetaminophen <2 g/day: combo may incr. risk of acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic metabolite formation)

tramadol + butalbital

avoid combo: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)

• butorphanol
Ultracet (tramadol/ acetaminophen)

+

butorphanol

1 interaction

Avoid/Use Alternative

tramadol + butorphanol

use alternative or monitor withdrawal sx, resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol efficacy, precipitate withdrawal in opioid dependent pts; may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus (antagonistic effects; additive effects)

• cabozantinib
Ultracet (tramadol/ acetaminophen)

+

cabozantinib

1 interaction

Avoid/Use Alternative

tramadol + cabozantinib

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• capivasertib
Ultracet (tramadol/ acetaminophen)

+

capivasertib

2 interactions

Avoid/Use Alternative

tramadol + capivasertib

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

Monitor/Modify Tx

acetaminophen + capivasertib

consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)

• carbamazepine
Ultracet (tramadol/ acetaminophen)

+

carbamazepine

2 interactions

Avoid/Use Alternative

acetaminophen + carbamazepine

use alternative or limit acetaminophen <2 g/day: combo may incr. risk of acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic metabolite formation)

tramadol + carbamazepine

avoid combo: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hyponatremia, serotonin syndrome; may alter seizure control (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• celecoxib
Ultracet (tramadol/ acetaminophen)

+

celecoxib

1 interaction

Avoid/Use Alternative

tramadol + celecoxib

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• cenobamate
Ultracet (tramadol/ acetaminophen)

+

cenobamate

1 interaction

Avoid/Use Alternative

tramadol + cenobamate

avoid combo: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• ceritinib
Ultracet (tramadol/ acetaminophen)

+

ceritinib

1 interaction

Avoid/Use Alternative

tramadol + ceritinib

use alternative or monitor resp. rate, ECG, electrolytes, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, additive effects)

• chloramphenicol
Ultracet (tramadol/ acetaminophen)

+

chloramphenicol

1 interaction

Avoid/Use Alternative

tramadol + chloramphenicol

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• chlordiazepoxide
Ultracet (tramadol/ acetaminophen)

+

chlordiazepoxide

1 interaction

Avoid/Use Alternative

tramadol + chlordiazepoxide

use alternative or monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• chloroquine
Ultracet (tramadol/ acetaminophen)

+

chloroquine

2 interactions

Avoid/Use Alternative

tramadol + chloroquine

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

Caution Advised

acetaminophen + chloroquine

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• chlorpromazine
Ultracet (tramadol/ acetaminophen)

+

chlorpromazine

1 interaction

Avoid/Use Alternative

tramadol + chlorpromazine

use alternative or monitor resp. rate, ECG, BP, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• cimetidine
Ultracet (tramadol/ acetaminophen)

+

cimetidine

1 interaction

Avoid/Use Alternative

tramadol + cimetidine

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• cinacalcet
Ultracet (tramadol/ acetaminophen)

+

cinacalcet

1 interaction

Avoid/Use Alternative

tramadol + cinacalcet

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• ciprofloxacin
Ultracet (tramadol/ acetaminophen)

+

ciprofloxacin

1 interaction

Avoid/Use Alternative

tramadol + ciprofloxacin

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• citalopram
Ultracet (tramadol/ acetaminophen)

+

citalopram

1 interaction

Avoid/Use Alternative

tramadol + citalopram

use alternative or monitor sodium, resp. rate, ECG, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hyponatremia, other adverse effects; may decr. tramadol active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• clarithromycin
Ultracet (tramadol/ acetaminophen)

+

clarithromycin

1 interaction

Avoid/Use Alternative

tramadol + clarithromycin

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• clobazam
Ultracet (tramadol/ acetaminophen)

+

clobazam

1 interaction

Avoid/Use Alternative

tramadol + clobazam

use alternative or monitor resp. rate, ECG, BP, withdrawal sx; use lowest effective doses and shortest duration of concomitant tx: combo may alter tramadol, decr. active metabolite levels, incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), other adverse effects or decr. efficacy; may alter seizure control (hepatic metab. altered, decr. conversion to active metabolite; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• clofazimine
Ultracet (tramadol/ acetaminophen)

+

clofazimine

1 interaction

Avoid/Use Alternative

tramadol + clofazimine

use alternative or monitor resp. rate, ECG, withdrawal sx; consider decr. tramadol dose: combo may incr. tramadol, alter active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite; additive effects)

• clomipramine
Ultracet (tramadol/ acetaminophen)

+

clomipramine

1 interaction

Avoid/Use Alternative

tramadol + clomipramine

use alternative or monitor sodium, ECG, BP, resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of QT prolongation, cardiac arrhythmias, profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe hyponatremia, seizures, serotonin syndrome, severe constipation, paralytic ileus, urinary retention (additive effects)

• clonazepam
Ultracet (tramadol/ acetaminophen)

+

clonazepam

1 interaction

Avoid/Use Alternative

tramadol + clonazepam

use alternative or monitor BP, resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• clonidine
Ultracet (tramadol/ acetaminophen)

+

clonidine

1 interaction

Avoid/Use Alternative

tramadol + clonidine

if ADHD use, avoid combo; otherwise, monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• clopidogrel
Ultracet (tramadol/ acetaminophen)

+

clopidogrel

1 interaction

Avoid/Use Alternative

tramadol + clopidogrel

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. clopidogrel and active metabolite levels, efficacy (absorption of clopidogrel possibly affected by delayed gastric emptying)

• clorazepate
Ultracet (tramadol/ acetaminophen)

+

clorazepate

1 interaction

Avoid/Use Alternative

tramadol + clorazepate

use alternative or monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• clozapine
Ultracet (tramadol/ acetaminophen)

+

clozapine

1 interaction

Avoid/Use Alternative

tramadol + clozapine

use alternative or monitor resp. rate, ECG, BP, HR, electrolytes, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus (incl. life-threatening), urinary retention, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. possibly inhibited, decr. conversion to active metabolite, additive effects)

• cobicistat
Ultracet (tramadol/ acetaminophen)

+

cobicistat

1 interaction

Avoid/Use Alternative

tramadol + cobicistat

use alternative or monitor resp. rate, ECG; consider decr. tramadol dose: combo may incr. tramadol, alter active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite)

• cocaine
Ultracet (tramadol/ acetaminophen)

+

cocaine

1 interaction

Avoid/Use Alternative

tramadol + cocaine

consider alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome, seizures (additive effects)

• codeine
Ultracet (tramadol/ acetaminophen)

+

codeine

1 interaction

Avoid/Use Alternative

tramadol + codeine

avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• conivaptan
Ultracet (tramadol/ acetaminophen)

+

conivaptan

1 interaction

Avoid/Use Alternative

tramadol + conivaptan

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose during and x7 days after conivaptan tx: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• crizotinib
Ultracet (tramadol/ acetaminophen)

+

crizotinib

1 interaction

Avoid/Use Alternative

tramadol + crizotinib

use alternative or monitor resp. rate, ECG, electrolytes; consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• cyclobenzaprine
Ultracet (tramadol/ acetaminophen)

+

cyclobenzaprine

1 interaction

Avoid/Use Alternative

tramadol + cyclobenzaprine

use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, severe constipation, paralytic ileus, urinary retention (additive effects)

• cyclosporine
Ultracet (tramadol/ acetaminophen)

+

cyclosporine

1 interaction

Avoid/Use Alternative

tramadol + cyclosporine

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• dabrafenib
Ultracet (tramadol/ acetaminophen)

+

dabrafenib

1 interaction

Avoid/Use Alternative

tramadol + dabrafenib

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• dacomitinib
Ultracet (tramadol/ acetaminophen)

+

dacomitinib

1 interaction

Avoid/Use Alternative

tramadol + dacomitinib

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• danazol
Ultracet (tramadol/ acetaminophen)

+

danazol

1 interaction

Avoid/Use Alternative

tramadol + danazol

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• danshen
Ultracet (tramadol/ acetaminophen)

+

danshen

1 interaction

Avoid/Use Alternative

tramadol + danshen

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• darifenacin
Ultracet (tramadol/ acetaminophen)

+

darifenacin

1 interaction

Avoid/Use Alternative

tramadol + darifenacin

use alternative or monitor resp. rate, ECG, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe constipation, paralytic ileus, urinary retention, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• darolutamide
Ultracet (tramadol/ acetaminophen)

+

darolutamide

1 interaction

Avoid/Use Alternative

tramadol + darolutamide

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy; may incr. risk of seizures (hepatic metab. induced; additive effects)

• darunavir
Ultracet (tramadol/ acetaminophen)

+

darunavir

1 interaction

Avoid/Use Alternative

tramadol + darunavir

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• degarelix
Ultracet (tramadol/ acetaminophen)

+

degarelix

1 interaction

Avoid/Use Alternative

tramadol + degarelix

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• desflurane
Ultracet (tramadol/ acetaminophen)

+

desflurane

1 interaction

Avoid/Use Alternative

tramadol + desflurane

use alternative or monitor resp. rate, BP, ECG; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• desipramine
Ultracet (tramadol/ acetaminophen)

+

desipramine

2 interactions

Avoid/Use Alternative

tramadol + desipramine

use alternative or monitor resp. rate, ECG, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of QT prolongation, cardiac arrhythmias, profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus, urinary retention (additive effects)

Caution Advised

acetaminophen + desipramine

caution advised w/ oral acetaminophen: combo may delay analgesic onset, decr. peak acetaminophen levels, efficacy (absorption delayed/reduced)

• desvenlafaxine
Ultracet (tramadol/ acetaminophen)

+

desvenlafaxine

1 interaction

Avoid/Use Alternative

tramadol + desvenlafaxine

use alternative or monitor sodium, resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, severe hyponatremia (additive effects)

• dexamethasone
Ultracet (tramadol/ acetaminophen)

+

dexamethasone

1 interaction

Avoid/Use Alternative

tramadol + dexamethasone

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy; may incr. risk of seizures (hepatic metab. induced; additive effects)

• dexmedetomidine
Ultracet (tramadol/ acetaminophen)

+

dexmedetomidine

1 interaction

Avoid/Use Alternative

tramadol + dexmedetomidine

avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• dexmedetomidine injection
Ultracet (tramadol/ acetaminophen)

+

dexmedetomidine injection

1 interaction

Avoid/Use Alternative

tramadol + dexmedetomidine injection

use alternative or monitor ECG, BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe or life-threatening hypotension (incl. orthostasis, syncope), QT prolongation, cardiac arrhythmias, bradycardia, AV block (additive effects)

• dexmethylphenidate
Ultracet (tramadol/ acetaminophen)

+

dexmethylphenidate

1 interaction

Avoid/Use Alternative

tramadol + dexmethylphenidate

use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome, seizures (additive effects)

• dextroamphetamine
Ultracet (tramadol/ acetaminophen)

+

dextroamphetamine

1 interaction

Avoid/Use Alternative

tramadol + dextroamphetamine

use alternative or decr. dextroamphetamine start dose; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome, seizures (additive effects)

• dextromethorphan
Ultracet (tramadol/ acetaminophen)

+

dextromethorphan

1 interaction

Avoid/Use Alternative

tramadol + dextromethorphan

use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)

• diazepam
Ultracet (tramadol/ acetaminophen)

+

diazepam

1 interaction

Avoid/Use Alternative

tramadol + diazepam

use alternative or monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• diclofenac
Ultracet (tramadol/ acetaminophen)

+

diclofenac

1 interaction

Avoid/Use Alternative

acetaminophen + diclofenac

use alternative or monitor LFTs; use lowest effective doses, shortest effective tx duration: combo may incr. risk of hepatotoxicity (possible additive effects)

• dicloxacillin
Ultracet (tramadol/ acetaminophen)

+

dicloxacillin

1 interaction

Avoid/Use Alternative

tramadol + dicloxacillin

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy; may incr. risk of seizures (hepatic metab. induced; additive effects)

• dihydrocodeine
Ultracet (tramadol/ acetaminophen)

+

dihydrocodeine

1 interaction

Avoid/Use Alternative

tramadol + dihydrocodeine

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• dihydroergotamine
Ultracet (tramadol/ acetaminophen)

+

dihydroergotamine

1 interaction

Avoid/Use Alternative

tramadol + dihydroergotamine

use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)

• diltiazem
Ultracet (tramadol/ acetaminophen)

+

diltiazem

1 interaction

Avoid/Use Alternative

tramadol + diltiazem

use alternative or monitor resp. rate, ECG, BP; consider decr. tramadol dose: combo may incr. tramadol, alter active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite; additive effects)

• diphenhydramine
Ultracet (tramadol/ acetaminophen)

+

diphenhydramine

1 interaction

Avoid/Use Alternative

tramadol + diphenhydramine

use alternative or monitor resp. rate, ECG, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe constipation, paralytic ileus, urinary retention, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• disopyramide
Ultracet (tramadol/ acetaminophen)

+

disopyramide

1 interaction

Avoid/Use Alternative

tramadol + disopyramide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, severe constipation, paralytic ileus, urinary retention (additive effects)

• dofetilide
Ultracet (tramadol/ acetaminophen)

+

dofetilide

1 interaction

Avoid/Use Alternative

tramadol + dofetilide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• donepezil
Ultracet (tramadol/ acetaminophen)

+

donepezil

1 interaction

Avoid/Use Alternative

tramadol + donepezil

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• doxepin
Ultracet (tramadol/ acetaminophen)

+

doxepin

1 interaction

Avoid/Use Alternative

tramadol + doxepin

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation, paralytic ileus, urinary retention (additive effects)

• doxepin topical
Ultracet (tramadol/ acetaminophen)

+

doxepin topical

1 interaction

Avoid/Use Alternative

tramadol + doxepin topical

use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe constipation, paralytic ileus, urinary retention (additive effects)

• doxylamine
Ultracet (tramadol/ acetaminophen)

+

doxylamine

1 interaction

Avoid/Use Alternative

tramadol + doxylamine

avoid combo if doxylamine use for pregnancy-related nausea/vomiting; otherwise, monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• droperidol
Ultracet (tramadol/ acetaminophen)

+

droperidol

1 interaction

Avoid/Use Alternative

tramadol + droperidol

use alternative or monitor resp. rate, ECG; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias (additive effects)

• duloxetine
Ultracet (tramadol/ acetaminophen)

+

duloxetine

1 interaction

Avoid/Use Alternative

tramadol + duloxetine

use alternative or monitor sodium, resp. rate, BP, ECG, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), severe hyponatremia, other adverse effects; may decr. tramadol active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• duvelisib
Ultracet (tramadol/ acetaminophen)

+

duvelisib

1 interaction

Avoid/Use Alternative

tramadol + duvelisib

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• echinacea
Ultracet (tramadol/ acetaminophen)

+

echinacea

1 interaction

Avoid/Use Alternative

tramadol + echinacea

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• efavirenz
Ultracet (tramadol/ acetaminophen)

+

efavirenz

1 interaction

Avoid/Use Alternative

tramadol + efavirenz

use alternative or monitor withdrawal sx, resp. rate, ECG; use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• elafibranor
Ultracet (tramadol/ acetaminophen)

+

elafibranor

1 interaction

Avoid/Use Alternative

tramadol + elafibranor

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• elagolix
Ultracet (tramadol/ acetaminophen)

+

elagolix

1 interaction

Avoid/Use Alternative

tramadol + elagolix

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• eletriptan
Ultracet (tramadol/ acetaminophen)

+

eletriptan

1 interaction

Avoid/Use Alternative

tramadol + eletriptan

consider alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)

• eliglustat
Ultracet (tramadol/ acetaminophen)

+

eliglustat

1 interaction

Avoid/Use Alternative

tramadol + eliglustat

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• eluxadoline
Ultracet (tramadol/ acetaminophen)

+

eluxadoline

1 interaction

Avoid/Use Alternative

tramadol + eluxadoline

avoid combo: combo may incr. risk of severe constipation, paralytic ileus (additive effects)

• enasidenib
Ultracet (tramadol/ acetaminophen)

+

enasidenib

1 interaction

Avoid/Use Alternative

tramadol + enasidenib

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. or decr. tramadol levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; hepatic metab. induced)

• encorafenib
Ultracet (tramadol/ acetaminophen)

+

encorafenib

1 interaction

Avoid/Use Alternative

tramadol + encorafenib

use alternative or monitor withdrawal sx, ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. tramadol levels, efficacy (additive effects; hepatic metab. induced)

• entrectinib
Ultracet (tramadol/ acetaminophen)

+

entrectinib

1 interaction

Avoid/Use Alternative

tramadol + entrectinib

avoid combo: combo may incr. risk of QT prolongation, cardiac arrhythmias, profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• enzalutamide
Ultracet (tramadol/ acetaminophen)

+

enzalutamide

1 interaction

Avoid/Use Alternative

tramadol + enzalutamide

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy; may incr. risk of seizures (hepatic metab. induced; additive effects)

• ephedra
Ultracet (tramadol/ acetaminophen)

+

ephedra

1 interaction

Avoid/Use Alternative

tramadol + ephedra

avoid combo: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• epirubicin
Ultracet (tramadol/ acetaminophen)

+

epirubicin

1 interaction

Avoid/Use Alternative

tramadol + epirubicin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ergotamine
Ultracet (tramadol/ acetaminophen)

+

ergotamine

1 interaction

Avoid/Use Alternative

tramadol + ergotamine

use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)

• eribulin
Ultracet (tramadol/ acetaminophen)

+

eribulin

1 interaction

Avoid/Use Alternative

tramadol + eribulin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• erythromycin
Ultracet (tramadol/ acetaminophen)

+

erythromycin

1 interaction

Avoid/Use Alternative

tramadol + erythromycin

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. erythromycin efficacy when used for GI promotility (hepatic metab. inhibited, may incr. production of active metabolite; additive effects; antagonistic effects)

• escitalopram
Ultracet (tramadol/ acetaminophen)

+

escitalopram

1 interaction

Avoid/Use Alternative

tramadol + escitalopram

use alternative or monitor sodium, resp. rate, ECG, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hyponatremia, other adverse effects; may decr. tramadol active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• esketamine
Ultracet (tramadol/ acetaminophen)

+

esketamine

1 interaction

Avoid/Use Alternative

tramadol + esketamine

use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• eslicarbazepine acetate
Ultracet (tramadol/ acetaminophen)

+

eslicarbazepine acetate

1 interaction

Avoid/Use Alternative

tramadol + eslicarbazepine acetate

use alternative or monitor withdrawal sx, resp. rate, sodium; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hyponatremia (incl. life-threatening), seizures (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• estazolam
Ultracet (tramadol/ acetaminophen)

+

estazolam

1 interaction

Avoid/Use Alternative

tramadol + estazolam

use alternative or monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• ethanol
Ultracet (tramadol/ acetaminophen)

+

ethanol

2 interactions

Avoid/Use Alternative

acetaminophen + ethanol

avoid combo in chronic alcoholics, otherwise caution advised: combo may incr. risk of hepatotoxicity (additive effects; hepatic metab. induced w/ incr. formation of toxic acetaminophen metabolites)

tramadol + ethanol

avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• ethinyl estradiol (contraceptive)
Ultracet (tramadol/ acetaminophen)

+

ethinyl estradiol (contraceptive)

1 interaction

Avoid/Use Alternative

tramadol + ethinyl estradiol (contraceptive)

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• etomidate
Ultracet (tramadol/ acetaminophen)

+

etomidate

1 interaction

Avoid/Use Alternative

tramadol + etomidate

use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• etrasimod
Ultracet (tramadol/ acetaminophen)

+

etrasimod

1 interaction

Avoid/Use Alternative

tramadol + etrasimod

consider alternative or monitor HR, ECG: combo may incr. risk of bradycardia, AV block, QT prolongation, cardiac arrhythmias (additive effects)

• etravirine
Ultracet (tramadol/ acetaminophen)

+

etravirine

1 interaction

Avoid/Use Alternative

tramadol + etravirine

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• fedratinib
Ultracet (tramadol/ acetaminophen)

+

fedratinib

1 interaction

Avoid/Use Alternative

tramadol + fedratinib

use alternative or monitor resp. rate, ECG, withdrawal sx; consider tramadol dose adjustment: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, conversion to active metabolite altered)

• felbamate
Ultracet (tramadol/ acetaminophen)

+

felbamate

1 interaction

Avoid/Use Alternative

tramadol + felbamate

use alternative or monitor withdrawal sx, resp. rate; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• felodipine
Ultracet (tramadol/ acetaminophen)

+

felodipine

1 interaction

Avoid/Use Alternative

tramadol + felodipine

use alternative or monitor resp. rate, ECG, BP, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• fenfluramine
Ultracet (tramadol/ acetaminophen)

+

fenfluramine

1 interaction

Avoid/Use Alternative

tramadol + fenfluramine

use alternative or monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• fentanyl
Ultracet (tramadol/ acetaminophen)

+

fentanyl

1 interaction

Avoid/Use Alternative

tramadol + fentanyl

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• fexinidazole
Ultracet (tramadol/ acetaminophen)

+

fexinidazole

1 interaction

Avoid/Use Alternative

tramadol + fexinidazole

if possible, do not initiate fexinidazole until 5 half-lives after tramadol D/C; use alternative or monitor withdrawal sx, ECG during and x7 days after fexinidazole tx: combo may decr. tramadol levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• flecainide
Ultracet (tramadol/ acetaminophen)

+

flecainide

1 interaction

Avoid/Use Alternative

tramadol + flecainide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• fluorouracil
Ultracet (tramadol/ acetaminophen)

+

fluorouracil

1 interaction

Avoid/Use Alternative

tramadol + fluorouracil

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• fluoxetine
Ultracet (tramadol/ acetaminophen)

+

fluoxetine

1 interaction

Avoid/Use Alternative

tramadol + fluoxetine

use alternative or monitor sodium, resp. rate, ECG, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hyponatremia, other adverse effects; may decr. tramadol active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• flurazepam
Ultracet (tramadol/ acetaminophen)

+

flurazepam

1 interaction

Avoid/Use Alternative

tramadol + flurazepam

use alternative or monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• fluvoxamine
Ultracet (tramadol/ acetaminophen)

+

fluvoxamine

1 interaction

Avoid/Use Alternative

tramadol + fluvoxamine

use alternative or monitor sodium, resp. rate, ECG, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hyponatremia, other adverse effects; may decr. tramadol active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• fosamprenavir
Ultracet (tramadol/ acetaminophen)

+

fosamprenavir

1 interaction

Avoid/Use Alternative

tramadol + fosamprenavir

use alternative or monitor resp. rate, ECG, withdrawal sx; consider tramadol dose adjustment: combo may alter tramadol, incr. active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metab. altered, may incr. production of active metabolite)

• foscarnet
Ultracet (tramadol/ acetaminophen)

+

foscarnet

1 interaction

Avoid/Use Alternative

tramadol + foscarnet

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• fosphenytoin
Ultracet (tramadol/ acetaminophen)

+

fosphenytoin

2 interactions

Avoid/Use Alternative

tramadol + fosphenytoin

avoid combo: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

Monitor/Modify Tx

acetaminophen + fosphenytoin

caution advised, limit acetaminophen <2 g/day: combo may incr. risk of acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic metabolite formation)

• frovatriptan
Ultracet (tramadol/ acetaminophen)

+

frovatriptan

1 interaction

Avoid/Use Alternative

tramadol + frovatriptan

use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)

• gabapentin
Ultracet (tramadol/ acetaminophen)

+

gabapentin

1 interaction

Avoid/Use Alternative

tramadol + gabapentin

use alternative or monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• garlic
Ultracet (tramadol/ acetaminophen)

+

garlic

1 interaction

Avoid/Use Alternative

tramadol + garlic

use alternative or monitor withdrawal sx, BP w/ supplemental garlic; dietary intake OK: combo may decr. tramadol levels, efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (hepatic metab. induced; additive effects)

• gefitinib
Ultracet (tramadol/ acetaminophen)

+

gefitinib

1 interaction

Avoid/Use Alternative

tramadol + gefitinib

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• gepirone
Ultracet (tramadol/ acetaminophen)

+

gepirone

1 interaction

Avoid/Use Alternative

tramadol + gepirone

use alternative or monitor ECG, electrolytes, serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of QT prolongation, cardiac arrhythmias, serotonin syndrome (additive effects)

• gepotidacin
Ultracet (tramadol/ acetaminophen)

+

gepotidacin

1 interaction

Avoid/Use Alternative

tramadol + gepotidacin

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• gilteritinib
Ultracet (tramadol/ acetaminophen)

+

gilteritinib

1 interaction

Avoid/Use Alternative

tramadol + gilteritinib

use alternative or monitor ECG, electrolytes, BP: combo may incr. risk of QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• ginkgo
Ultracet (tramadol/ acetaminophen)

+

ginkgo

1 interaction

Avoid/Use Alternative

tramadol + ginkgo

avoid consumption of ginkgo seeds; otherwise, use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy; may incr. risk of seizures (hepatic metab. induced; additive effects)

• ginseng, Asian
Ultracet (tramadol/ acetaminophen)

+

ginseng, Asian

1 interaction

Avoid/Use Alternative

tramadol + ginseng, Asian

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• givinostat
Ultracet (tramadol/ acetaminophen)

+

givinostat

1 interaction

Avoid/Use Alternative

tramadol + givinostat

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• givosiran
Ultracet (tramadol/ acetaminophen)

+

givosiran

1 interaction

Avoid/Use Alternative

tramadol + givosiran

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; givosiran effects on hepatic heme biosynthesis may reduce CYP450 enzyme activity)

• glasdegib
Ultracet (tramadol/ acetaminophen)

+

glasdegib

1 interaction

Avoid/Use Alternative

tramadol + glasdegib

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• glycerol phenylbutyrate
Ultracet (tramadol/ acetaminophen)

+

glycerol phenylbutyrate

1 interaction

Avoid/Use Alternative

tramadol + glycerol phenylbutyrate

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• goserelin
Ultracet (tramadol/ acetaminophen)

+

goserelin

1 interaction

Avoid/Use Alternative

tramadol + goserelin

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects, androgen deprivation may prolong QT)

• granisetron
Ultracet (tramadol/ acetaminophen)

+

granisetron

2 interactions

Avoid/Use Alternative

tramadol + granisetron

use alternative or monitor ECG, serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of QT prolongation, cardiac arrhythmias, serotonin syndrome (additive effects)

Caution Advised

acetaminophen + granisetron

caution advised: combo may decr. acetaminophen analgesic efficacy (mechanism unknown, possible 5-HT3 antagonism)

• grapefruit
Ultracet (tramadol/ acetaminophen)

+

grapefruit

1 interaction

Avoid/Use Alternative

tramadol + grapefruit

consider avoiding grapefruit juice: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (GI metab. inhibited, may incr. production of active metabolite, additive effects)

• griseofulvin
Ultracet (tramadol/ acetaminophen)

+

griseofulvin

1 interaction

Avoid/Use Alternative

tramadol + griseofulvin

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• haloperidol
Ultracet (tramadol/ acetaminophen)

+

haloperidol

1 interaction

Avoid/Use Alternative

tramadol + haloperidol

use alternative or monitor resp. rate, ECG, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• histrelin
Ultracet (tramadol/ acetaminophen)

+

histrelin

1 interaction

Avoid/Use Alternative

tramadol + histrelin

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects, androgen deprivation prolongs QT)

• hydralazine
Ultracet (tramadol/ acetaminophen)

+

hydralazine

1 interaction

Avoid/Use Alternative

tramadol + hydralazine

use alternative or monitor resp. rate, ECG, BP, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• hydrocodone
Ultracet (tramadol/ acetaminophen)

+

hydrocodone

1 interaction

Avoid/Use Alternative

tramadol + hydrocodone

avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, ECG, electrolytes, especially if hydrocodone ER doses >160 mg/day, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, QT prolongation, cardiac arrhythmias, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• hydromorphone
Ultracet (tramadol/ acetaminophen)

+

hydromorphone

1 interaction

Avoid/Use Alternative

tramadol + hydromorphone

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• hydroxychloroquine
Ultracet (tramadol/ acetaminophen)

+

hydroxychloroquine

1 interaction

Avoid/Use Alternative

tramadol + hydroxychloroquine

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• hydroxyzine
Ultracet (tramadol/ acetaminophen)

+

hydroxyzine

1 interaction

Avoid/Use Alternative

tramadol + hydroxyzine

use alternative or monitor ECG, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of QT prolongation, cardiac arrhythmias, profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• ibutilide
Ultracet (tramadol/ acetaminophen)

+

ibutilide

1 interaction

Avoid/Use Alternative

tramadol + ibutilide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• idelalisib
Ultracet (tramadol/ acetaminophen)

+

idelalisib

1 interaction

Avoid/Use Alternative

tramadol + idelalisib

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• iloperidone
Ultracet (tramadol/ acetaminophen)

+

iloperidone

1 interaction

Avoid/Use Alternative

tramadol + iloperidone

use alternative or monitor resp. rate, ECG, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• imatinib
Ultracet (tramadol/ acetaminophen)

+

imatinib

1 interaction

Avoid/Use Alternative

tramadol + imatinib

use alternative or monitor resp. rate, ECG, withdrawal sx; consider decr. tramadol dose: combo may incr. tramadol, alter active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite)

• imipramine
Ultracet (tramadol/ acetaminophen)

+

imipramine

1 interaction

Avoid/Use Alternative

tramadol + imipramine

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• inotuzumab ozogamicin
Ultracet (tramadol/ acetaminophen)

+

inotuzumab ozogamicin

1 interaction

Avoid/Use Alternative

tramadol + inotuzumab ozogamicin

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• iohexol
Ultracet (tramadol/ acetaminophen)

+

iohexol

1 interaction

Avoid/Use Alternative

tramadol + iohexol

avoid combo if intrathecal iohexol use: combo may incr. risk of seizures (additive effects)

• isavuconazonium
Ultracet (tramadol/ acetaminophen)

+

isavuconazonium

1 interaction

Avoid/Use Alternative

tramadol + isavuconazonium

use alternative or monitor resp. rate, ECG; consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• isoniazid
Ultracet (tramadol/ acetaminophen)

+

isoniazid

2 interactions

Avoid/Use Alternative

tramadol + isoniazid

use alternative or monitor resp. rate, serotonin syndrome sx w/in 14 days of isoniazid use, especially during initiation/titration: combo may incr. risk of seizures, resp. depression, serotonin syndrome (additive effects, isoniazid inhibits monoamine oxidase)

Caution Advised

acetaminophen + isoniazid

caution advised: combo may incr. acetaminophen reactive intermediate metabolite levels, risk of hepatotoxicity, other adverse effects (hepatic metab. possibly induced, incr. formation of toxic metabolite)

• itraconazole
Ultracet (tramadol/ acetaminophen)

+

itraconazole

1 interaction

Avoid/Use Alternative

tramadol + itraconazole

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose during and x2wk after itraconazole tx: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• ivabradine
Ultracet (tramadol/ acetaminophen)

+

ivabradine

1 interaction

Avoid/Use Alternative

tramadol + ivabradine

consider alternative or monitor HR, ECG: combo may incr. risk of bradycardia, AV block, QT prolongation, cardiac arrhythmias (additive effects)

• ivosidenib
Ultracet (tramadol/ acetaminophen)

+

ivosidenib

1 interaction

Avoid/Use Alternative

tramadol + ivosidenib

use alternative or monitor ECG, electrolytes, withdrawal sx: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. tramadol levels, efficacy (additive effects; hepatic metab. induced)

• kava
Ultracet (tramadol/ acetaminophen)

+

kava

1 interaction

Avoid/Use Alternative

tramadol + kava

avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• ketamine
Ultracet (tramadol/ acetaminophen)

+

ketamine

1 interaction

Avoid/Use Alternative

tramadol + ketamine

use alternative or monitor resp. rate; decr. dose of one or both drugs; use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression (incl. life-threatening), psychomotor impairment, seizures, delayed recovery from anesthesia (additive effects)

• ketoconazole
Ultracet (tramadol/ acetaminophen)

+

ketoconazole

2 interactions

Avoid/Use Alternative

tramadol + ketoconazole

use alternative or monitor resp. rate, ECG; consider decr. tramadol dose during and up to 1wk after ketoconazole tx: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

Monitor/Modify Tx

acetaminophen + ketoconazole

consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)

• kratom
Ultracet (tramadol/ acetaminophen)

+

kratom

1 interaction

Avoid/Use Alternative

tramadol + kratom

use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures (additive effects)

• labetalol
Ultracet (tramadol/ acetaminophen)

+

labetalol

1 interaction

Avoid/Use Alternative

tramadol + labetalol

use alternative or monitor resp. rate, ECG, BP, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. tramadol active metabolite levels, efficacy (hepatic metab inhibited; additive effects)

• lasmiditan
Ultracet (tramadol/ acetaminophen)

+

lasmiditan

1 interaction

Avoid/Use Alternative

tramadol + lasmiditan

consider alternative or monitor serotonin syndrome sx, especially during initiation/titration; monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of serotonin syndrome, profound CNS and resp. depression, psychomotor impairment (additive effects)

• lefamulin
Ultracet (tramadol/ acetaminophen)

+

lefamulin

1 interaction

Avoid/Use Alternative

tramadol + lefamulin

ORAL LEFAMULIN: use alternative or monitor resp. rate, ECG, consider decr. tramadol dose; IV LEFAMULIN: use alternative or monitor ECG: combo w/ oral lefamulin may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; combo w/ IV lefamulin may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• lenacapavir
Ultracet (tramadol/ acetaminophen)

+

lenacapavir

1 interaction

Avoid/Use Alternative

tramadol + lenacapavir

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose during and x9mo after lenacapavir tx: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• letermovir
Ultracet (tramadol/ acetaminophen)

+

letermovir

1 interaction

Avoid/Use Alternative

tramadol + letermovir

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• leuprolide
Ultracet (tramadol/ acetaminophen)

+

leuprolide

1 interaction

Avoid/Use Alternative

tramadol + leuprolide

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects, androgen deprivation may prolong QT)

• levofloxacin
Ultracet (tramadol/ acetaminophen)

+

levofloxacin

1 interaction

Avoid/Use Alternative

tramadol + levofloxacin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• levomilnacipran
Ultracet (tramadol/ acetaminophen)

+

levomilnacipran

1 interaction

Avoid/Use Alternative

tramadol + levomilnacipran

use alternative or monitor sodium, resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hyponatremia, serotonin syndrome, seizures (additive effects)

• levorphanol
Ultracet (tramadol/ acetaminophen)

+

levorphanol

1 interaction

Avoid/Use Alternative

tramadol + levorphanol

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. levorphanol start dose by at least 50%, consider decr. tramadol dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• lisdexamfetamine
Ultracet (tramadol/ acetaminophen)

+

lisdexamfetamine

1 interaction

Avoid/Use Alternative

tramadol + lisdexamfetamine

use alternative or decr. lisdexamfetamine dose; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome, seizures (additive effects)

• lithium
Ultracet (tramadol/ acetaminophen)

+

lithium

1 interaction

Avoid/Use Alternative

tramadol + lithium

use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome, seizures (additive effects)

• lofexidine
Ultracet (tramadol/ acetaminophen)

+

lofexidine

1 interaction

Avoid/Use Alternative

tramadol + lofexidine

use alternative or monitor ECG, BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of QT prolongation, cardiac arrhythmias, profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• lonafarnib
Ultracet (tramadol/ acetaminophen)

+

lonafarnib

1 interaction

Avoid/Use Alternative

tramadol + lonafarnib

use alternative or monitor HR, ECG, electrolytes, resp. rate; consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite, additive effects)

• loperamide
Ultracet (tramadol/ acetaminophen)

+

loperamide

1 interaction

Avoid/Use Alternative

tramadol + loperamide

use alternative or monitor ECG, esp. if loperamide dose >16mg/day: combo may incr. risk of QT prolongation, cardiac arrhythmias, severe constipation, paralytic ileus (additive effects)

• lopinavir/ritonavir
Ultracet (tramadol/ acetaminophen)

+

lopinavir/ ritonavir

2 interactions

Avoid/Use Alternative

tramadol + lopinavir/ ritonavir

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may alter tramadol, active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metab. altered, may alter production of active metabolite; additive effects)

Monitor/Modify Tx

acetaminophen + lopinavir/ ritonavir

consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)

• lorazepam
Ultracet (tramadol/ acetaminophen)

+

lorazepam

1 interaction

Avoid/Use Alternative

tramadol + lorazepam

use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• lorlatinib
Ultracet (tramadol/ acetaminophen)

+

lorlatinib

1 interaction

Avoid/Use Alternative

tramadol + lorlatinib

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy; may incr. risk of seizures (hepatic metab. induced; additive effects)

• lumacaftor/ivacaftor
Ultracet (tramadol/ acetaminophen)

+

lumacaftor/ ivacaftor

1 interaction

Avoid/Use Alternative

tramadol + lumacaftor/ ivacaftor

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• macimorelin
Ultracet (tramadol/ acetaminophen)

+

macimorelin

1 interaction

Avoid/Use Alternative

tramadol + macimorelin

avoid combo, allowing sufficient washout time before diagnostic test: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• mavacamten
Ultracet (tramadol/ acetaminophen)

+

mavacamten

1 interaction

Avoid/Use Alternative

tramadol + mavacamten

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• mavorixafor
Ultracet (tramadol/ acetaminophen)

+

mavorixafor

1 interaction

Avoid/Use Alternative

tramadol + mavorixafor

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite, additive effects)

• meperidine
Ultracet (tramadol/ acetaminophen)

+

meperidine

1 interaction

Avoid/Use Alternative

tramadol + meperidine

use alternative or monitor resp. rate, ECG, BP, serotonin syndrome sx, especially during initiation/titration; decr. meperidine dose 25-50%, consider decr. tramadol dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• metaxalone
Ultracet (tramadol/ acetaminophen)

+

metaxalone

1 interaction

Avoid/Use Alternative

tramadol + metaxalone

use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)

• methadone
Ultracet (tramadol/ acetaminophen)

+

methadone

1 interaction

Avoid/Use Alternative

tramadol + methadone

use alternative or monitor resp. rate, BP, ECG, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, other adverse effects; may decr. tramadol active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• methamphetamine
Ultracet (tramadol/ acetaminophen)

+

methamphetamine

1 interaction

Avoid/Use Alternative

tramadol + methamphetamine

use alternative or decr. methamphetamine start dose; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome, seizures (additive effects)

• methohexital
Ultracet (tramadol/ acetaminophen)

+

methohexital

1 interaction

Avoid/Use Alternative

tramadol + methohexital

use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• methylergonovine
Ultracet (tramadol/ acetaminophen)

+

methylergonovine

1 interaction

Avoid/Use Alternative

tramadol + methylergonovine

use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)

• methylphenidate
Ultracet (tramadol/ acetaminophen)

+

methylphenidate

1 interaction

Avoid/Use Alternative

tramadol + methylphenidate

use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome, seizures (additive effects)

• metoclopramide
Ultracet (tramadol/ acetaminophen)

+

metoclopramide

1 interaction

Avoid/Use Alternative

tramadol + metoclopramide

use alternative or monitor resp. rate, decr. dose of one or both drugs; use lowest effective doses and shortest duration of concomitant tx; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures; may decr. metoclopramide efficacy (additive effects; antagonistic effects; absorption of oral metoclopramide affected by delayed gastric emptying)

• metyrapone
Ultracet (tramadol/ acetaminophen)

+

metyrapone

2 interactions

Avoid/Use Alternative

acetaminophen + metyrapone

avoid combo: combo may incr. acetaminophen and toxic metabolite levels, risk of adverse effects (UGT possibly inhibited, possible incr. toxic metabolite formation)

Monitor/Modify Tx

tramadol + metyrapone

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• midazolam
Ultracet (tramadol/ acetaminophen)

+

midazolam

1 interaction

Avoid/Use Alternative

tramadol + midazolam

use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• mifepristone
Ultracet (tramadol/ acetaminophen)

+

mifepristone

1 interaction

Avoid/Use Alternative

tramadol + mifepristone

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose during and x14 days after daily mifepristone use; caution advised if pregnancy termination use: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• milnacipran
Ultracet (tramadol/ acetaminophen)

+

milnacipran

1 interaction

Avoid/Use Alternative

tramadol + milnacipran

use alternative or monitor sodium, resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hyponatremia, serotonin syndrome, seizures (additive effects)

• mirabegron
Ultracet (tramadol/ acetaminophen)

+

mirabegron

1 interaction

Avoid/Use Alternative

tramadol + mirabegron

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• mirtazapine
Ultracet (tramadol/ acetaminophen)

+

mirtazapine

1 interaction

Avoid/Use Alternative

tramadol + mirtazapine

use alternative or monitor sodium, resp. rate, ECG, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hyponatremia, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• mitapivat
Ultracet (tramadol/ acetaminophen)

+

mitapivat

1 interaction

Avoid/Use Alternative

tramadol + mitapivat

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• mitotane
Ultracet (tramadol/ acetaminophen)

+

mitotane

1 interaction

Avoid/Use Alternative

tramadol + mitotane

use alternative or monitor withdrawal sx, resp. rate; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)

• mobocertinib
Ultracet (tramadol/ acetaminophen)

+

mobocertinib

1 interaction

Avoid/Use Alternative

tramadol + mobocertinib

use alternative or monitor withdrawal sx, ECG, electrolytes: combo may decr. tramadol levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• modafinil
Ultracet (tramadol/ acetaminophen)

+

modafinil

1 interaction

Avoid/Use Alternative

tramadol + modafinil

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• morphine
Ultracet (tramadol/ acetaminophen)

+

morphine

2 interactions

Avoid/Use Alternative

tramadol + morphine

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus (additive effects)

Caution Advised

acetaminophen + morphine

caution advised w/ oral acetaminophen: combo may delay analgesic onset, decr. peak acetaminophen levels, efficacy (absorption delayed/reduced)

• moxifloxacin
Ultracet (tramadol/ acetaminophen)

+

moxifloxacin

1 interaction

Avoid/Use Alternative

tramadol + moxifloxacin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• nafcillin
Ultracet (tramadol/ acetaminophen)

+

nafcillin

1 interaction

Avoid/Use Alternative

tramadol + nafcillin

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy; may incr. risk of seizures (hepatic metab. induced; additive effects)

• nalbuphine
Ultracet (tramadol/ acetaminophen)

+

nalbuphine

1 interaction

Avoid/Use Alternative

tramadol + nalbuphine

use alternative or monitor withdrawal sx, resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol efficacy, precipitate withdrawal in opioid dependent pts; may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus (antagonistic effects; additive effects)

• naratriptan
Ultracet (tramadol/ acetaminophen)

+

naratriptan

1 interaction

Avoid/Use Alternative

tramadol + naratriptan

consider alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)

• nefazodone
Ultracet (tramadol/ acetaminophen)

+

nefazodone

1 interaction

Avoid/Use Alternative

tramadol + nefazodone

use alternative or monitor resp. rate, ECG, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol and active metabolite levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of tramadol active metabolite; additive effects)

• nelfinavir
Ultracet (tramadol/ acetaminophen)

+

nelfinavir

1 interaction

Avoid/Use Alternative

tramadol + nelfinavir

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• netupitant
Ultracet (tramadol/ acetaminophen)

+

netupitant

1 interaction

Avoid/Use Alternative

tramadol + netupitant

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose during and x1wk after (fos)netupitant tx: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• nevirapine
Ultracet (tramadol/ acetaminophen)

+

nevirapine

1 interaction

Avoid/Use Alternative

tramadol + nevirapine

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• nilotinib
Ultracet (tramadol/ acetaminophen)

+

nilotinib

1 interaction

Avoid/Use Alternative

tramadol + nilotinib

avoid combo: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hyponatremia, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• nirogacestat
Ultracet (tramadol/ acetaminophen)

+

nirogacestat

1 interaction

Avoid/Use Alternative

tramadol + nirogacestat

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• nortriptyline
Ultracet (tramadol/ acetaminophen)

+

nortriptyline

1 interaction

Avoid/Use Alternative

tramadol + nortriptyline

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• odevixibat
Ultracet (tramadol/ acetaminophen)

+

odevixibat

1 interaction

Avoid/Use Alternative

tramadol + odevixibat

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• oliceridine
Ultracet (tramadol/ acetaminophen)

+

oliceridine

1 interaction

Avoid/Use Alternative

tramadol + oliceridine

use alternative or monitor resp. rate, ECG, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• omaveloxolone
Ultracet (tramadol/ acetaminophen)

+

omaveloxolone

1 interaction

Avoid/Use Alternative

tramadol + omaveloxolone

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• ondansetron
Ultracet (tramadol/ acetaminophen)

+

ondansetron

1 interaction

Avoid/Use Alternative

tramadol + ondansetron

use alternative or monitor ECG, serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of QT prolongation, cardiac arrhythmias, serotonin syndrome (additive effects)

• opium
Ultracet (tramadol/ acetaminophen)

+

opium

1 interaction

Avoid/Use Alternative

tramadol + opium

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus (additive effects)

• osilodrostat
Ultracet (tramadol/ acetaminophen)

+

osilodrostat

1 interaction

Avoid/Use Alternative

tramadol + osilodrostat

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• osimertinib
Ultracet (tramadol/ acetaminophen)

+

osimertinib

1 interaction

Avoid/Use Alternative

tramadol + osimertinib

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• oxaliplatin
Ultracet (tramadol/ acetaminophen)

+

oxaliplatin

1 interaction

Avoid/Use Alternative

tramadol + oxaliplatin

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• oxazepam
Ultracet (tramadol/ acetaminophen)

+

oxazepam

1 interaction

Avoid/Use Alternative

tramadol + oxazepam

use alternative or monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• oxcarbazepine
Ultracet (tramadol/ acetaminophen)

+

oxcarbazepine

1 interaction

Avoid/Use Alternative

tramadol + oxcarbazepine

use alternative or monitor withdrawal sx, resp. rate, sodium; use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hyponatremia; may alter seizure control, may decr. tramadol levels, efficacy (additive effects; antagonistic effects, tramadol may decr. seizure threshold; hepatic metab. induced)

• oxybate
Ultracet (tramadol/ acetaminophen)

+

oxybate

1 interaction

Avoid/Use Alternative

tramadol + oxybate

use alternative or monitor resp. rate; consider holding oxybate, especially if peri- or post-operative opioid analgesia required: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, hypotension, syncope (additive effects)

• oxycodone
Ultracet (tramadol/ acetaminophen)

+

oxycodone

1 interaction

Avoid/Use Alternative

tramadol + oxycodone

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. oxycodone start dose by at least 50%, consider decr. tramadol dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• oxymorphone
Ultracet (tramadol/ acetaminophen)

+

oxymorphone

1 interaction

Avoid/Use Alternative

tramadol + oxymorphone

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. oxymorphone start dose by at least 50%, consider decr. tramadol dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• ozanimod
Ultracet (tramadol/ acetaminophen)

+

ozanimod

1 interaction

Avoid/Use Alternative

tramadol + ozanimod

consider alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• pacritinib
Ultracet (tramadol/ acetaminophen)

+

pacritinib

1 interaction

Avoid/Use Alternative

tramadol + pacritinib

avoid combo: combo may decr. tramadol levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• paliperidone
Ultracet (tramadol/ acetaminophen)

+

paliperidone

1 interaction

Avoid/Use Alternative

tramadol + paliperidone

use alternative or monitor resp. rate, ECG, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• palonosetron
Ultracet (tramadol/ acetaminophen)

+

palonosetron

1 interaction

Avoid/Use Alternative

tramadol + palonosetron

use alternative or monitor ECG, serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of QT prolongation, cardiac arrhythmias, serotonin syndrome (additive effects)

• panobinostat
Ultracet (tramadol/ acetaminophen)

+

panobinostat

1 interaction

Avoid/Use Alternative

tramadol + panobinostat

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• paroxetine
Ultracet (tramadol/ acetaminophen)

+

paroxetine

1 interaction

Avoid/Use Alternative

tramadol + paroxetine

use alternative or monitor sodium, resp. rate, ECG, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hyponatremia, other adverse effects; may decr. tramadol active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• pasireotide
Ultracet (tramadol/ acetaminophen)

+

pasireotide

1 interaction

Avoid/Use Alternative

tramadol + pasireotide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• pazopanib
Ultracet (tramadol/ acetaminophen)

+

pazopanib

1 interaction

Avoid/Use Alternative

tramadol + pazopanib

avoid combo: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• pentamidine
Ultracet (tramadol/ acetaminophen)

+

pentamidine

1 interaction

Avoid/Use Alternative

tramadol + pentamidine

use alternative or monitor ECG, BP; risk may be lower w/ nebulized pentamidine: combo may incr. risk of QT prolongation, cardiac arrhythmias, severe or life-threatening hypotension, incl. orthostasis, syncope (additive effects)

• pentazocine
Ultracet (tramadol/ acetaminophen)

+

pentazocine

1 interaction

Avoid/Use Alternative

tramadol + pentazocine

use alternative or monitor withdrawal sx, resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol efficacy, precipitate withdrawal in opioid dependent pts; may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (antagonistic effects; additive effects)

• pentobarbital
Ultracet (tramadol/ acetaminophen)

+

pentobarbital

2 interactions

Avoid/Use Alternative

acetaminophen + pentobarbital

use alternative or limit acetaminophen <2 g/day: combo may incr. risk of acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic metabolite formation)

tramadol + pentobarbital

use alternative or monitor withdrawal sx, resp. rate, BP; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (hepatic metab. induced; additive effects)

• perampanel
Ultracet (tramadol/ acetaminophen)

+

perampanel

1 interaction

Avoid/Use Alternative

tramadol + perampanel

use alternative or monitor resp. rate, withdrawal sx; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol levels, efficacy if on perampanel 12 mg/day; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• pexidartinib
Ultracet (tramadol/ acetaminophen)

+

pexidartinib

2 interactions

Avoid/Use Alternative

tramadol + pexidartinib

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

Monitor/Modify Tx

acetaminophen + pexidartinib

consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT possibly inhibited)

• phenobarbital
Ultracet (tramadol/ acetaminophen)

+

phenobarbital

1 interaction

Avoid/Use Alternative

tramadol + phenobarbital

avoid combo: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope; may alter seizure control (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• phenytoin
Ultracet (tramadol/ acetaminophen)

+

phenytoin

2 interactions

Avoid/Use Alternative

tramadol + phenytoin

avoid combo: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

Monitor/Modify Tx

acetaminophen + phenytoin

caution advised, limit acetaminophen <2 g/day: combo may incr. risk of acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic metabolite formation)

• pimavanserin
Ultracet (tramadol/ acetaminophen)

+

pimavanserin

1 interaction

Avoid/Use Alternative

tramadol + pimavanserin

avoid combo: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• pioglitazone
Ultracet (tramadol/ acetaminophen)

+

pioglitazone

1 interaction

Avoid/Use Alternative

tramadol + pioglitazone

use alternative or monitor withdrawal sx, glucose: combo may decr. tramadol levels, efficacy; may incr. risk of severe hypoglycemia (hepatic metab. induced; additive effects)

• pitolisant
Ultracet (tramadol/ acetaminophen)

+

pitolisant

1 interaction

Avoid/Use Alternative

tramadol + pitolisant

avoid combo: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ponesimod
Ultracet (tramadol/ acetaminophen)

+

ponesimod

1 interaction

Avoid/Use Alternative

tramadol + ponesimod

use alternative or monitor HR, ECG: combo may incr. risk of bradycardia, AV block, QT prolongation, cardiac arrhythmias (additive effects)

• pramlintide
Ultracet (tramadol/ acetaminophen)

+

pramlintide

2 interactions

Avoid/Use Alternative

tramadol + pramlintide

consider alternative or monitor glucose: combo may incr. risk of severe hypoglycemia, severe constipation, paralytic ileus (additive effects)

Monitor/Modify Tx

acetaminophen + pramlintide

give 1h before or 2h after pramlintide: combo may delay analgesic onset, decr. peak acetaminophen levels and efficacy (absorption delayed/decreased)

• prasugrel
Ultracet (tramadol/ acetaminophen)

+

prasugrel

1 interaction

Avoid/Use Alternative

tramadol + prasugrel

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. prasugrel active metabolite levels, efficacy (absorption of prasugrel possibly affected by delayed gastric emptying)

• prednisone
Ultracet (tramadol/ acetaminophen)

+

prednisone

1 interaction

Avoid/Use Alternative

tramadol + prednisone

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy; may incr. risk of seizures (hepatic metab. induced; additive effects)

• pregabalin
Ultracet (tramadol/ acetaminophen)

+

pregabalin

1 interaction

Avoid/Use Alternative

tramadol + pregabalin

use alternative or monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• primidone
Ultracet (tramadol/ acetaminophen)

+

primidone

2 interactions

Avoid/Use Alternative

acetaminophen + primidone

use alternative or limit acetaminophen <2 g/day: combo may incr. risk of acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic metabolite formation)

tramadol + primidone

avoid combo: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• procainamide
Ultracet (tramadol/ acetaminophen)

+

procainamide

1 interaction

Avoid/Use Alternative

tramadol + procainamide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• prochlorperazine
Ultracet (tramadol/ acetaminophen)

+

prochlorperazine

1 interaction

Avoid/Use Alternative

tramadol + prochlorperazine

consider alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• promethazine
Ultracet (tramadol/ acetaminophen)

+

promethazine

1 interaction

Avoid/Use Alternative

tramadol + promethazine

use alternative or monitor resp. rate, ECG, BP; decr. tramadol by at least 25-50%, consider decr. promethazine dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• propafenone
Ultracet (tramadol/ acetaminophen)

+

propafenone

1 interaction

Avoid/Use Alternative

tramadol + propafenone

use alternative or monitor resp. rate, ECG, BP, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• propranolol
Ultracet (tramadol/ acetaminophen)

+

propranolol

1 interaction

Avoid/Use Alternative

tramadol + propranolol

use alternative or monitor resp. rate, ECG, withdrawal sx, BP: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• protriptyline
Ultracet (tramadol/ acetaminophen)

+

protriptyline

1 interaction

Avoid/Use Alternative

tramadol + protriptyline

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• quazepam
Ultracet (tramadol/ acetaminophen)

+

quazepam

1 interaction

Avoid/Use Alternative

tramadol + quazepam

use alternative or monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• quetiapine
Ultracet (tramadol/ acetaminophen)

+

quetiapine

1 interaction

Avoid/Use Alternative

tramadol + quetiapine

use alternative or monitor resp. rate, ECG, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• quinidine (antiarrhythmic)
Ultracet (tramadol/ acetaminophen)

+

quinidine (antiarrhythmic)

1 interaction

Avoid/Use Alternative

tramadol + quinidine (antiarrhythmic)

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• quinine
Ultracet (tramadol/ acetaminophen)

+

quinine

1 interaction

Avoid/Use Alternative

tramadol + quinine

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• quizartinib
Ultracet (tramadol/ acetaminophen)

+

quizartinib

1 interaction

Avoid/Use Alternative

tramadol + quizartinib

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ranolazine
Ultracet (tramadol/ acetaminophen)

+

ranolazine

1 interaction

Avoid/Use Alternative

tramadol + ranolazine

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of QT prolongation, cardiac arrhythmias, CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• remifentanil
Ultracet (tramadol/ acetaminophen)

+

remifentanil

1 interaction

Avoid/Use Alternative

tramadol + remifentanil

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, seizures, severe constipation, paralytic ileus (additive effects)

• remimazolam
Ultracet (tramadol/ acetaminophen)

+

remimazolam

1 interaction

Avoid/Use Alternative

tramadol + remimazolam

use alternative or monitor BP, resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of severe hypotension (incl. orthostasis, syncope), profound CNS and resp. depression, psychomotor impairment (additive effects)

• repotrectinib
Ultracet (tramadol/ acetaminophen)

+

repotrectinib

1 interaction

Avoid/Use Alternative

tramadol + repotrectinib

use alternative or monitor resp. rate, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)

• revefenacin inhaled
Ultracet (tramadol/ acetaminophen)

+

revefenacin inhaled

1 interaction

Avoid/Use Alternative

tramadol + revefenacin inhaled

consider alternative: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• revumenib
Ultracet (tramadol/ acetaminophen)

+

revumenib

1 interaction

Avoid/Use Alternative

tramadol + revumenib

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ribociclib
Ultracet (tramadol/ acetaminophen)

+

ribociclib

1 interaction

Avoid/Use Alternative

tramadol + ribociclib

use alternative or monitor resp. rate, ECG, electrolytes; consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• rifabutin
Ultracet (tramadol/ acetaminophen)

+

rifabutin

2 interactions

Avoid/Use Alternative

tramadol + rifabutin

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

Monitor/Modify Tx

acetaminophen + rifabutin

limit acetaminophen <2 g/day: combo may incr. risk of acetaminophen toxicity, decr. efficacy (hepatic metab. induced, increased toxic metabolite formation)

• rifampin
Ultracet (tramadol/ acetaminophen)

+

rifampin

2 interactions

Avoid/Use Alternative

acetaminophen + rifampin

use alternative or limit acetaminophen <2 g/day: combo may incr. risk of acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic metabolite formation)

tramadol + rifampin

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• rifapentine
Ultracet (tramadol/ acetaminophen)

+

rifapentine

1 interaction

Avoid/Use Alternative

tramadol + rifapentine

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• rilpivirine
Ultracet (tramadol/ acetaminophen)

+

rilpivirine

1 interaction

Avoid/Use Alternative

tramadol + rilpivirine

consider alternative or monitor ECG; risk may be lower w/ IM rilpivirine: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ritonavir
Ultracet (tramadol/ acetaminophen)

+

ritonavir

1 interaction

Avoid/Use Alternative

tramadol + ritonavir

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol, alter active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite)

• rizatriptan
Ultracet (tramadol/ acetaminophen)

+

rizatriptan

1 interaction

Avoid/Use Alternative

tramadol + rizatriptan

use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)

• rolapitant
Ultracet (tramadol/ acetaminophen)

+

rolapitant

1 interaction

Avoid/Use Alternative

tramadol + rolapitant

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• romidepsin
Ultracet (tramadol/ acetaminophen)

+

romidepsin

1 interaction

Avoid/Use Alternative

tramadol + romidepsin

use alternative or monitor ECG, sodium: combo may incr. risk of QT prolongation, cardiac arrhythmias, severe hyponatremia (additive effects)

• ropeginterferon alfa-2b
Ultracet (tramadol/ acetaminophen)

+

ropeginterferon alfa-2b

1 interaction

Avoid/Use Alternative

tramadol + ropeginterferon alfa-2b

use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• rucaparib
Ultracet (tramadol/ acetaminophen)

+

rucaparib

1 interaction

Avoid/Use Alternative

tramadol + rucaparib

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• rufinamide
Ultracet (tramadol/ acetaminophen)

+

rufinamide

1 interaction

Avoid/Use Alternative

tramadol + rufinamide

use alternative or monitor withdrawal sx, resp. rate; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• SAMe
Ultracet (tramadol/ acetaminophen)

+

SAMe

1 interaction

Avoid/Use Alternative

tramadol + SAMe

use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)

• sarilumab
Ultracet (tramadol/ acetaminophen)

+

sarilumab

1 interaction

Avoid/Use Alternative

tramadol + sarilumab

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. altered; sarilumab may reverse inflammatory cytokine-induced downregulation of CYP450 enzymes resulting in relative induction of enzymes upon tx start and downregulation upon D/C)

• selpercatinib
Ultracet (tramadol/ acetaminophen)

+

selpercatinib

1 interaction

Avoid/Use Alternative

tramadol + selpercatinib

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• sertraline
Ultracet (tramadol/ acetaminophen)

+

sertraline

1 interaction

Avoid/Use Alternative

tramadol + sertraline

use alternative or monitor sodium, resp. rate, ECG, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hyponatremia, other adverse effects; may decr. tramadol active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• siponimod
Ultracet (tramadol/ acetaminophen)

+

siponimod

1 interaction

Avoid/Use Alternative

tramadol + siponimod

consider alternative or monitor HR, ECG: combo may incr. risk of bradycardia, AV block, QT prolongation, cardiac arrhythmias (additive effects)

• solifenacin
Ultracet (tramadol/ acetaminophen)

+

solifenacin

1 interaction

Avoid/Use Alternative

tramadol + solifenacin

use alternative or monitor ECG, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of QT prolongation, cardiac arrhythmias, severe constipation, paralytic ileus, urinary retention, profound CNS and resp. depression, psychomotor impairment (additive effects)

• somatropin
Ultracet (tramadol/ acetaminophen)

+

somatropin

1 interaction

Avoid/Use Alternative

tramadol + somatropin

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• sorafenib
Ultracet (tramadol/ acetaminophen)

+

sorafenib

2 interactions

Avoid/Use Alternative

tramadol + sorafenib

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

Monitor/Modify Tx

acetaminophen + sorafenib

consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)

• sotalol
Ultracet (tramadol/ acetaminophen)

+

sotalol

1 interaction

Avoid/Use Alternative

tramadol + sotalol

use alternative or monitor ECG, BP: combo may incr. risk of QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• sotorasib
Ultracet (tramadol/ acetaminophen)

+

sotorasib

1 interaction

Avoid/Use Alternative

tramadol + sotorasib

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• St. John's wort
Ultracet (tramadol/ acetaminophen)

+

St. John's wort

1 interaction

Avoid/Use Alternative

tramadol + St. John's wort

use alternative or monitor withdrawal sx, serotonin syndrome sx, especially during initiation/titration: combo may decr. tramadol levels, efficacy; may incr. risk of serotonin syndrome (hepatic metab. induced; additive effects)

• sufentanil
Ultracet (tramadol/ acetaminophen)

+

sufentanil

1 interaction

Avoid/Use Alternative

tramadol + sufentanil

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. sufentanil start dose, consider decr. tramadol dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, seizures, severe constipation, paralytic ileus (additive effects)

• sumatriptan
Ultracet (tramadol/ acetaminophen)

+

sumatriptan

1 interaction

Avoid/Use Alternative

tramadol + sumatriptan

use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures (additive effects)

• suzetrigine
Ultracet (tramadol/ acetaminophen)

+

suzetrigine

1 interaction

Avoid/Use Alternative

tramadol + suzetrigine

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• tapentadol
Ultracet (tramadol/ acetaminophen)

+

tapentadol

1 interaction

Avoid/Use Alternative

tramadol + tapentadol

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)

• tazemetostat
Ultracet (tramadol/ acetaminophen)

+

tazemetostat

1 interaction

Avoid/Use Alternative

tramadol + tazemetostat

use alternative or monitor withdrawal sx, ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. tramadol levels, efficacy (additive effects; hepatic metab. induced)

• tecovirimat
Ultracet (tramadol/ acetaminophen)

+

tecovirimat

1 interaction

Avoid/Use Alternative

tramadol + tecovirimat

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• telavancin
Ultracet (tramadol/ acetaminophen)

+

telavancin

1 interaction

Avoid/Use Alternative

tramadol + telavancin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• telotristat ethyl
Ultracet (tramadol/ acetaminophen)

+

telotristat ethyl

1 interaction

Avoid/Use Alternative

tramadol + telotristat ethyl

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• temazepam
Ultracet (tramadol/ acetaminophen)

+

temazepam

1 interaction

Avoid/Use Alternative

tramadol + temazepam

use alternative or monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• terbinafine
Ultracet (tramadol/ acetaminophen)

+

terbinafine

1 interaction

Avoid/Use Alternative

tramadol + terbinafine

use alternative or monitor resp. rate, ECG, withdrawal sx: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• tetrabenazine
Ultracet (tramadol/ acetaminophen)

+

tetrabenazine

1 interaction

Avoid/Use Alternative

tramadol + tetrabenazine

use alternative or monitor resp. rate, ECG, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias (additive effects)

• thalidomide
Ultracet (tramadol/ acetaminophen)

+

thalidomide

1 interaction

Avoid/Use Alternative

tramadol + thalidomide

use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• ticagrelor
Ultracet (tramadol/ acetaminophen)

+

ticagrelor

1 interaction

Avoid/Use Alternative

tramadol + ticagrelor

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• tipranavir
Ultracet (tramadol/ acetaminophen)

+

tipranavir

1 interaction

Avoid/Use Alternative

tramadol + tipranavir

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol, alter active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite)

• tocilizumab
Ultracet (tramadol/ acetaminophen)

+

tocilizumab

1 interaction

Avoid/Use Alternative

tramadol + tocilizumab

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. altered; tocilizumab may reverse inflammatory cytokine-induced downregulation of CYP450 enzymes resulting in relative induction of enzymes)

• topiramate
Ultracet (tramadol/ acetaminophen)

+

topiramate

1 interaction

Avoid/Use Alternative

tramadol + topiramate

use alternative or monitor withdrawal sx especially w/ topiramate doses >200 mg/day, resp. rate; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• toremifene
Ultracet (tramadol/ acetaminophen)

+

toremifene

1 interaction

Avoid/Use Alternative

tramadol + toremifene

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• tovorafenib
Ultracet (tramadol/ acetaminophen)

+

tovorafenib

1 interaction

Avoid/Use Alternative

tramadol + tovorafenib

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• tramadol
Ultracet (tramadol/ acetaminophen)

+

tramadol

1 interaction

Avoid/Use Alternative

tramadol + tramadol

avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation, paralytic ileus, other adverse effects (additive effects, duplicate tx)

• trazodone
Ultracet (tramadol/ acetaminophen)

+

trazodone

1 interaction

Avoid/Use Alternative

tramadol + trazodone

use alternative or monitor resp. rate, ECG, BP, sodium, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), severe hyponatremia, serotonin syndrome (additive effects)

• triazolam
Ultracet (tramadol/ acetaminophen)

+

triazolam

1 interaction

Avoid/Use Alternative

tramadol + triazolam

use alternative or monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• triclabendazole
Ultracet (tramadol/ acetaminophen)

+

triclabendazole

1 interaction

Avoid/Use Alternative

tramadol + triclabendazole

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• trifluridine
Ultracet (tramadol/ acetaminophen)

+

trifluridine

1 interaction

Avoid/Use Alternative

tramadol + trifluridine

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• trimipramine
Ultracet (tramadol/ acetaminophen)

+

trimipramine

1 interaction

Avoid/Use Alternative

tramadol + trimipramine

use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation, paralytic ileus, urinary retention (additive effects)

• triptorelin
Ultracet (tramadol/ acetaminophen)

+

triptorelin

1 interaction

Avoid/Use Alternative

tramadol + triptorelin

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects, androgen deprivation prolongs QT)

• tucatinib
Ultracet (tramadol/ acetaminophen)

+

tucatinib

1 interaction

Avoid/Use Alternative

tramadol + tucatinib

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• upadacitinib
Ultracet (tramadol/ acetaminophen)

+

upadacitinib

1 interaction

Avoid/Use Alternative

tramadol + upadacitinib

use alternative or monitor resp. rate, ECG, withdrawal sx if taking upadacitinib dose 45 mg qd: combo may incr. tramadol levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)

• vandetanib
Ultracet (tramadol/ acetaminophen)

+

vandetanib

1 interaction

Avoid/Use Alternative

tramadol + vandetanib

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• vemurafenib
Ultracet (tramadol/ acetaminophen)

+

vemurafenib

1 interaction

Avoid/Use Alternative

tramadol + vemurafenib

use alternative or monitor resp. rate, ECG, electrolytes, withdrawal sx: combo may alter tramadol, decr. active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects or decr. efficacy (hepatic metab. altered, decr. conversion to active metabolite; additive effects)

• venlafaxine
Ultracet (tramadol/ acetaminophen)

+

venlafaxine

1 interaction

Avoid/Use Alternative

tramadol + venlafaxine

use alternative or monitor sodium, resp. rate, ECG, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, severe hyponatremia, serotonin syndrome, seizures, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite; additive effects)

• verapamil
Ultracet (tramadol/ acetaminophen)

+

verapamil

1 interaction

Avoid/Use Alternative

tramadol + verapamil

use alternative or monitor resp. rate, ECG, BP; consider decr. tramadol dose: combo may incr. tramadol, alter active metabolite levels, incr. risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite; additive effects)

• vilazodone
Ultracet (tramadol/ acetaminophen)

+

vilazodone

1 interaction

Avoid/Use Alternative

tramadol + vilazodone

use alternative or monitor resp. rate, sodium, serotonin syndrome sx, especially during initiation/titration, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hyponatremia, seizures (additive effects)

• viloxazine
Ultracet (tramadol/ acetaminophen)

+

viloxazine

1 interaction

Avoid/Use Alternative

tramadol + viloxazine

use alternative or monitor resp. rate, ECG, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. tramadol levels, risk of profound CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. active metabolite levels, efficacy (hepatic metab. inhibited, decr. conversion to active metabolite, additive effects)

• vinblastine
Ultracet (tramadol/ acetaminophen)

+

vinblastine

1 interaction

Avoid/Use Alternative

tramadol + vinblastine

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• voriconazole
Ultracet (tramadol/ acetaminophen)

+

voriconazole

1 interaction

Avoid/Use Alternative

tramadol + voriconazole

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite; additive effects)

• vortioxetine
Ultracet (tramadol/ acetaminophen)

+

vortioxetine

1 interaction

Avoid/Use Alternative

tramadol + vortioxetine

use alternative or monitor sodium, serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of severe hyponatremia, serotonin syndrome (additive effects)

• zanubrutinib
Ultracet (tramadol/ acetaminophen)

+

zanubrutinib

1 interaction

Avoid/Use Alternative

tramadol + zanubrutinib

use alternative or monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. induced)

• ziprasidone
Ultracet (tramadol/ acetaminophen)

+

ziprasidone

1 interaction

Avoid/Use Alternative

tramadol + ziprasidone

use alternative or monitor resp. rate, BP, ECG, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, seizures, QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• zolmitriptan
Ultracet (tramadol/ acetaminophen)

+

zolmitriptan

1 interaction

Avoid/Use Alternative

tramadol + zolmitriptan

consider alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)

• zuranolone
Ultracet (tramadol/ acetaminophen)

+

zuranolone

1 interaction

Avoid/Use Alternative

tramadol + zuranolone

use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

Monitor/Modify Tx

• acebutolol
Ultracet (tramadol/ acetaminophen)

+

acebutolol

1 interaction

Monitor/Modify Tx

tramadol + acebutolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• acetaminophen
Ultracet (tramadol/ acetaminophen)

+

acetaminophen

1 interaction

Monitor/Modify Tx

acetaminophen + acetaminophen

limit acetaminophen from all sources to standard max acetaminophen doses: combo may incr. risk of acetaminophen toxicity (duplicate tx)

• acetazolamide
Ultracet (tramadol/ acetaminophen)

+

acetazolamide

1 interaction

Monitor/Modify Tx

tramadol + acetazolamide

monitor sodium; caution advised if seizure disorder use: combo may incr. risk of severe hyponatremia; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• albuterol
Ultracet (tramadol/ acetaminophen)

+

albuterol

1 interaction

Monitor/Modify Tx

tramadol + albuterol

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• albuterol inhaled
Ultracet (tramadol/ acetaminophen)

+

albuterol inhaled

1 interaction

Monitor/Modify Tx

tramadol + albuterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• alfuzosin
Ultracet (tramadol/ acetaminophen)

+

alfuzosin

1 interaction

Monitor/Modify Tx

tramadol + alfuzosin

monitor ECG, BP: combo may incr. risk of QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• aliskiren
Ultracet (tramadol/ acetaminophen)

+

aliskiren

1 interaction

Monitor/Modify Tx

tramadol + aliskiren

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• allopurinol
Ultracet (tramadol/ acetaminophen)

+

allopurinol

1 interaction

Monitor/Modify Tx

tramadol + allopurinol

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• alogliptin
Ultracet (tramadol/ acetaminophen)

+

alogliptin

1 interaction

Monitor/Modify Tx

tramadol + alogliptin

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• amantadine
Ultracet (tramadol/ acetaminophen)

+

amantadine

1 interaction

Monitor/Modify Tx

tramadol + amantadine

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• amifostine
Ultracet (tramadol/ acetaminophen)

+

amifostine

1 interaction

Monitor/Modify Tx

tramadol + amifostine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• amiloride
Ultracet (tramadol/ acetaminophen)

+

amiloride

1 interaction

Monitor/Modify Tx

tramadol + amiloride

monitor sodium, BP: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope; may decr. amiloride efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• amisulpride
Ultracet (tramadol/ acetaminophen)

+

amisulpride

1 interaction

Monitor/Modify Tx

tramadol + amisulpride

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• amlodipine
Ultracet (tramadol/ acetaminophen)

+

amlodipine

1 interaction

Monitor/Modify Tx

tramadol + amlodipine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• apraclonidine ophthalmic
Ultracet (tramadol/ acetaminophen)

+

apraclonidine ophthalmic

1 interaction

Monitor/Modify Tx

tramadol + apraclonidine ophthalmic

monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx if apraclonidine IOP adjunct use; postop use OK: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• aprocitentan
Ultracet (tramadol/ acetaminophen)

+

aprocitentan

1 interaction

Monitor/Modify Tx

tramadol + aprocitentan

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• arformoterol inhaled
Ultracet (tramadol/ acetaminophen)

+

arformoterol inhaled

1 interaction

Monitor/Modify Tx

tramadol + arformoterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• aripiprazole bimonthly injection
Ultracet (tramadol/ acetaminophen)

+

aripiprazole bimonthly injection

1 interaction

Monitor/Modify Tx

tramadol + aripiprazole bimonthly injection

monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of seizures, profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• aripiprazole lauroxil
Ultracet (tramadol/ acetaminophen)

+

aripiprazole lauroxil

1 interaction

Monitor/Modify Tx

tramadol + aripiprazole lauroxil

monitor BP, resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• aripiprazole monthly injection
Ultracet (tramadol/ acetaminophen)

+

aripiprazole monthly injection

1 interaction

Monitor/Modify Tx

tramadol + aripiprazole monthly injection

monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• aripiprazole oral
Ultracet (tramadol/ acetaminophen)

+

aripiprazole oral

1 interaction

Monitor/Modify Tx

tramadol + aripiprazole oral

monitor BP, resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• articaine
Ultracet (tramadol/ acetaminophen)

+

articaine

2 interactions

Monitor/Modify Tx

tramadol + articaine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

Caution Advised

acetaminophen + articaine

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• asciminib
Ultracet (tramadol/ acetaminophen)

+

asciminib

1 interaction

Monitor/Modify Tx

tramadol + asciminib

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• atenolol
Ultracet (tramadol/ acetaminophen)

+

atenolol

1 interaction

Monitor/Modify Tx

tramadol + atenolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• atracurium
Ultracet (tramadol/ acetaminophen)

+

atracurium

1 interaction

Monitor/Modify Tx

tramadol + atracurium

monitor resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of resp. depression, potentiate, prolong neuromuscular blockade (additive effects)

• avanafil
Ultracet (tramadol/ acetaminophen)

+

avanafil

1 interaction

Monitor/Modify Tx

tramadol + avanafil

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• azilsartan medoxomil
Ultracet (tramadol/ acetaminophen)

+

azilsartan medoxomil

1 interaction

Monitor/Modify Tx

tramadol + azilsartan medoxomil

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• baclofen
Ultracet (tramadol/ acetaminophen)

+

baclofen

1 interaction

Monitor/Modify Tx

tramadol + baclofen

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures (additive effects)

• belumosudil
Ultracet (tramadol/ acetaminophen)

+

belumosudil

1 interaction

Monitor/Modify Tx

acetaminophen + belumosudil

consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)

• benazepril
Ultracet (tramadol/ acetaminophen)

+

benazepril

1 interaction

Monitor/Modify Tx

tramadol + benazepril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• betaxolol
Ultracet (tramadol/ acetaminophen)

+

betaxolol

1 interaction

Monitor/Modify Tx

tramadol + betaxolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• betaxolol ophthalmic
Ultracet (tramadol/ acetaminophen)

+

betaxolol ophthalmic

1 interaction

Monitor/Modify Tx

tramadol + betaxolol ophthalmic

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• bethanechol
Ultracet (tramadol/ acetaminophen)

+

bethanechol

1 interaction

Monitor/Modify Tx

tramadol + bethanechol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• bexagliflozin
Ultracet (tramadol/ acetaminophen)

+

bexagliflozin

1 interaction

Monitor/Modify Tx

tramadol + bexagliflozin

monitor glucose, BP: combo may incr. risk of severe hypoglycemia, severe hypotension, incl. orthostasis, syncope (additive effects)

• bisoprolol
Ultracet (tramadol/ acetaminophen)

+

bisoprolol

1 interaction

Monitor/Modify Tx

tramadol + bisoprolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• bortezomib
Ultracet (tramadol/ acetaminophen)

+

bortezomib

1 interaction

Monitor/Modify Tx

tramadol + bortezomib

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• brexpiprazole
Ultracet (tramadol/ acetaminophen)

+

brexpiprazole

1 interaction

Monitor/Modify Tx

tramadol + brexpiprazole

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• brimonidine ophthalmic
Ultracet (tramadol/ acetaminophen)

+

brimonidine ophthalmic

1 interaction

Monitor/Modify Tx

tramadol + brimonidine ophthalmic

monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx if elevated IOP use; OTC ocular redness use OK: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• brimonidine topical
Ultracet (tramadol/ acetaminophen)

+

brimonidine topical

1 interaction

Monitor/Modify Tx

tramadol + brimonidine topical

monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• brivaracetam
Ultracet (tramadol/ acetaminophen)

+

brivaracetam

1 interaction

Monitor/Modify Tx

tramadol + brivaracetam

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• brompheniramine
Ultracet (tramadol/ acetaminophen)

+

brompheniramine

1 interaction

Monitor/Modify Tx

tramadol + brompheniramine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• bumetanide
Ultracet (tramadol/ acetaminophen)

+

bumetanide

1 interaction

Monitor/Modify Tx

tramadol + bumetanide

monitor sodium, BP: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope; may decr. bumetanide efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• bupivacaine
Ultracet (tramadol/ acetaminophen)

+

bupivacaine

2 interactions

Monitor/Modify Tx

tramadol + bupivacaine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

Caution Advised

acetaminophen + bupivacaine

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• bupivacaine liposomal
Ultracet (tramadol/ acetaminophen)

+

bupivacaine liposomal

2 interactions

Monitor/Modify Tx

tramadol + bupivacaine liposomal

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

Caution Advised

acetaminophen + bupivacaine liposomal

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• cabergoline
Ultracet (tramadol/ acetaminophen)

+

cabergoline

1 interaction

Monitor/Modify Tx

tramadol + cabergoline

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• canagliflozin
Ultracet (tramadol/ acetaminophen)

+

canagliflozin

1 interaction

Monitor/Modify Tx

tramadol + canagliflozin

monitor BP, glucose: combo may incr. risk of severe hypoglycemia, severe hypotension, incl. orthostasis, syncope (additive effects)

• candesartan cilexetil
Ultracet (tramadol/ acetaminophen)

+

candesartan cilexetil

1 interaction

Monitor/Modify Tx

tramadol + candesartan cilexetil

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• cannabidiol
Ultracet (tramadol/ acetaminophen)

+

cannabidiol

1 interaction

Monitor/Modify Tx

tramadol + cannabidiol

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• cannabis
Ultracet (tramadol/ acetaminophen)

+

cannabis

1 interaction

Monitor/Modify Tx

tramadol + cannabis

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• captopril
Ultracet (tramadol/ acetaminophen)

+

captopril

1 interaction

Monitor/Modify Tx

tramadol + captopril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• carbinoxamine
Ultracet (tramadol/ acetaminophen)

+

carbinoxamine

1 interaction

Monitor/Modify Tx

tramadol + carbinoxamine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• cariprazine
Ultracet (tramadol/ acetaminophen)

+

cariprazine

1 interaction

Monitor/Modify Tx

tramadol + cariprazine

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• carisoprodol
Ultracet (tramadol/ acetaminophen)

+

carisoprodol

1 interaction

Monitor/Modify Tx

tramadol + carisoprodol

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• carteolol ophthalmic
Ultracet (tramadol/ acetaminophen)

+

carteolol ophthalmic

1 interaction

Monitor/Modify Tx

tramadol + carteolol ophthalmic

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• carvedilol
Ultracet (tramadol/ acetaminophen)

+

carvedilol

1 interaction

Monitor/Modify Tx

tramadol + carvedilol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• cetirizine
Ultracet (tramadol/ acetaminophen)

+

cetirizine

1 interaction

Monitor/Modify Tx

tramadol + cetirizine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• chamomile, German
Ultracet (tramadol/ acetaminophen)

+

chamomile, German

1 interaction

Monitor/Modify Tx

tramadol + chamomile, German

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• chlophedianol
Ultracet (tramadol/ acetaminophen)

+

chlophedianol

1 interaction

Monitor/Modify Tx

tramadol + chlophedianol

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• chloroprocaine
Ultracet (tramadol/ acetaminophen)

+

chloroprocaine

2 interactions

Monitor/Modify Tx

tramadol + chloroprocaine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

Caution Advised

acetaminophen + chloroprocaine

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• chlorothiazide
Ultracet (tramadol/ acetaminophen)

+

chlorothiazide

1 interaction

Monitor/Modify Tx

tramadol + chlorothiazide

monitor sodium, BP: combo may incr. risk of severe hyponatremia, seizures, severe hypotension, incl. orthostasis, syncope; may decr. chlorothiazide efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• chlorpheniramine
Ultracet (tramadol/ acetaminophen)

+

chlorpheniramine

1 interaction

Monitor/Modify Tx

tramadol + chlorpheniramine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• chlorthalidone
Ultracet (tramadol/ acetaminophen)

+

chlorthalidone

1 interaction

Monitor/Modify Tx

tramadol + chlorthalidone

monitor sodium, BP: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope; may decr. chlorthalidone efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• chlorzoxazone
Ultracet (tramadol/ acetaminophen)

+

chlorzoxazone

1 interaction

Monitor/Modify Tx

tramadol + chlorzoxazone

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• cilostazol
Ultracet (tramadol/ acetaminophen)

+

cilostazol

1 interaction

Monitor/Modify Tx

tramadol + cilostazol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• cisatracurium
Ultracet (tramadol/ acetaminophen)

+

cisatracurium

1 interaction

Monitor/Modify Tx

tramadol + cisatracurium

monitor resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of resp. depression, potentiate, prolong neuromuscular blockade, seizures (additive effects)

• cisplatin
Ultracet (tramadol/ acetaminophen)

+

cisplatin

1 interaction

Monitor/Modify Tx

tramadol + cisplatin

monitor sodium: combo may incr. risk of severe hyponatremia (additive effects)

• clemastine
Ultracet (tramadol/ acetaminophen)

+

clemastine

1 interaction

Monitor/Modify Tx

tramadol + clemastine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• clevidipine
Ultracet (tramadol/ acetaminophen)

+

clevidipine

1 interaction

Monitor/Modify Tx

tramadol + clevidipine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• clofarabine
Ultracet (tramadol/ acetaminophen)

+

clofarabine

1 interaction

Monitor/Modify Tx

tramadol + clofarabine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• coenzyme Q-10
Ultracet (tramadol/ acetaminophen)

+

coenzyme Q-10

1 interaction

Monitor/Modify Tx

tramadol + coenzyme Q-10

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• colesevelam
Ultracet (tramadol/ acetaminophen)

+

colesevelam

1 interaction

Monitor/Modify Tx

tramadol + colesevelam

monitor glucose in type 2 diabetes mellitus pts: combo may incr. risk of severe hypoglycemia (additive effects)

• cyclophosphamide
Ultracet (tramadol/ acetaminophen)

+

cyclophosphamide

1 interaction

Monitor/Modify Tx

tramadol + cyclophosphamide

monitor sodium: combo may incr. risk of severe hyponatremia, incl. life-threatening (additive effects)

• cyproheptadine
Ultracet (tramadol/ acetaminophen)

+

cyproheptadine

1 interaction

Monitor/Modify Tx

tramadol + cyproheptadine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• dantrolene
Ultracet (tramadol/ acetaminophen)

+

dantrolene

1 interaction

Monitor/Modify Tx

tramadol + dantrolene

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• dapagliflozin
Ultracet (tramadol/ acetaminophen)

+

dapagliflozin

1 interaction

Monitor/Modify Tx

tramadol + dapagliflozin

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• daridorexant
Ultracet (tramadol/ acetaminophen)

+

daridorexant

1 interaction

Monitor/Modify Tx

tramadol + daridorexant

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• dasatinib
Ultracet (tramadol/ acetaminophen)

+

dasatinib

1 interaction

Monitor/Modify Tx

tramadol + dasatinib

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• denileukin diftitox
Ultracet (tramadol/ acetaminophen)

+

denileukin diftitox

1 interaction

Monitor/Modify Tx

tramadol + denileukin diftitox

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• desmopressin
Ultracet (tramadol/ acetaminophen)

+

desmopressin

1 interaction

Monitor/Modify Tx

tramadol + desmopressin

monitor sodium: combo may incr. risk of severe hyponatremia, incl. life-threatening (additive effects)

• deutetrabenazine
Ultracet (tramadol/ acetaminophen)

+

deutetrabenazine

1 interaction

Monitor/Modify Tx

tramadol + deutetrabenazine

monitor ECG, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of QT prolongation, cardiac arrhythmias, profound CNS and resp. depression, psychomotor impairment (additive effects)

• dexbrompheniramine
Ultracet (tramadol/ acetaminophen)

+

dexbrompheniramine

1 interaction

Monitor/Modify Tx

tramadol + dexbrompheniramine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• dexchlorpheniramine
Ultracet (tramadol/ acetaminophen)

+

dexchlorpheniramine

1 interaction

Monitor/Modify Tx

tramadol + dexchlorpheniramine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• dichlorphenamide
Ultracet (tramadol/ acetaminophen)

+

dichlorphenamide

1 interaction

Monitor/Modify Tx

tramadol + dichlorphenamide

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• difelikefalin
Ultracet (tramadol/ acetaminophen)

+

difelikefalin

1 interaction

Monitor/Modify Tx

tramadol + difelikefalin

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• difenoxin
Ultracet (tramadol/ acetaminophen)

+

difenoxin

1 interaction

Monitor/Modify Tx

tramadol + difenoxin

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus (additive effects)

• digoxin
Ultracet (tramadol/ acetaminophen)

+

digoxin

1 interaction

Monitor/Modify Tx

tramadol + digoxin

monitor digoxin levels, HR: combo may incr. digoxin levels, risk of bradycardia, AV block, other adverse effects (mechanism unknown)

• dimenhydrinate
Ultracet (tramadol/ acetaminophen)

+

dimenhydrinate

1 interaction

Monitor/Modify Tx

tramadol + dimenhydrinate

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• dinutuximab
Ultracet (tramadol/ acetaminophen)

+

dinutuximab

1 interaction

Monitor/Modify Tx

tramadol + dinutuximab

monitor BP, sodium: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope (additive effects)

• diphenoxylate
Ultracet (tramadol/ acetaminophen)

+

diphenoxylate

1 interaction

Monitor/Modify Tx

tramadol + diphenoxylate

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus (additive effects)

• dipyridamole
Ultracet (tramadol/ acetaminophen)

+

dipyridamole

1 interaction

Monitor/Modify Tx

tramadol + dipyridamole

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• doxazosin
Ultracet (tramadol/ acetaminophen)

+

doxazosin

1 interaction

Monitor/Modify Tx

tramadol + doxazosin

monitor BP, especially during doxazosin initiation/titration; caution advised w/ doxazosin ER dosage form: combo may incr. risk of severe hypotension, incl. orthostasis, syncope; may incr. doxazosin levels, risk of adverse effects (additive effects; absorption increased)

• dronabinol
Ultracet (tramadol/ acetaminophen)

+

dronabinol

1 interaction

Monitor/Modify Tx

tramadol + dronabinol

monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• empagliflozin
Ultracet (tramadol/ acetaminophen)

+

empagliflozin

1 interaction

Monitor/Modify Tx

tramadol + empagliflozin

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• enalapril
Ultracet (tramadol/ acetaminophen)

+

enalapril

1 interaction

Monitor/Modify Tx

tramadol + enalapril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• enalaprilat
Ultracet (tramadol/ acetaminophen)

+

enalaprilat

1 interaction

Monitor/Modify Tx

tramadol + enalaprilat

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• entacapone
Ultracet (tramadol/ acetaminophen)

+

entacapone

1 interaction

Monitor/Modify Tx

tramadol + entacapone

monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• eplerenone
Ultracet (tramadol/ acetaminophen)

+

eplerenone

1 interaction

Monitor/Modify Tx

tramadol + eplerenone

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• epoprostenol
Ultracet (tramadol/ acetaminophen)

+

epoprostenol

1 interaction

Monitor/Modify Tx

tramadol + epoprostenol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• ertugliflozin
Ultracet (tramadol/ acetaminophen)

+

ertugliflozin

1 interaction

Monitor/Modify Tx

tramadol + ertugliflozin

monitor glucose, BP: combo may incr. risk of severe hypoglycemia, severe hypotension, incl. orthostasis, syncope (additive effects)

• esmolol
Ultracet (tramadol/ acetaminophen)

+

esmolol

1 interaction

Monitor/Modify Tx

tramadol + esmolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• eszopiclone
Ultracet (tramadol/ acetaminophen)

+

eszopiclone

1 interaction

Monitor/Modify Tx

tramadol + eszopiclone

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• ethacrynic acid
Ultracet (tramadol/ acetaminophen)

+

ethacrynic acid

1 interaction

Monitor/Modify Tx

tramadol + ethacrynic acid

monitor sodium, BP: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope; may decr. ethacrynic acid efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• ethanol (in some formulations)
Ultracet (tramadol/ acetaminophen)

+

ethanol (in some formulations)

1 interaction

Monitor/Modify Tx

tramadol + ethanol (in some formulations)

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• ethosuximide
Ultracet (tramadol/ acetaminophen)

+

ethosuximide

1 interaction

Monitor/Modify Tx

tramadol + ethosuximide

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• exenatide
Ultracet (tramadol/ acetaminophen)

+

exenatide

2 interactions

Monitor/Modify Tx

acetaminophen + exenatide

give oral acetaminophen at least 1h before twice daily exenatide; caution w/ weekly exenatide: combo may delay analgesic onset, decr. peak acetaminophen levels, efficacy (absorption delayed, possibly decreased)

tramadol + exenatide

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• fenoldopam
Ultracet (tramadol/ acetaminophen)

+

fenoldopam

1 interaction

Monitor/Modify Tx

tramadol + fenoldopam

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• fenoprofen
Ultracet (tramadol/ acetaminophen)

+

fenoprofen

1 interaction

Monitor/Modify Tx

acetaminophen + fenoprofen

monitor renal fxn, especially w/ long-term concomitant tx: combo may incr. risk of nephrotoxicity (additive effects)

• ferumoxytol
Ultracet (tramadol/ acetaminophen)

+

ferumoxytol

1 interaction

Monitor/Modify Tx

tramadol + ferumoxytol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• fesoterodine
Ultracet (tramadol/ acetaminophen)

+

fesoterodine

1 interaction

Monitor/Modify Tx

tramadol + fesoterodine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• fingolimod
Ultracet (tramadol/ acetaminophen)

+

fingolimod

1 interaction

Monitor/Modify Tx

tramadol + fingolimod

monitor ECG overnight during fingolimod initiation/titration: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• flaxseed
Ultracet (tramadol/ acetaminophen)

+

flaxseed

1 interaction

Monitor/Modify Tx

tramadol + flaxseed

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• flibanserin
Ultracet (tramadol/ acetaminophen)

+

flibanserin

1 interaction

Monitor/Modify Tx

tramadol + flibanserin

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• fluphenazine
Ultracet (tramadol/ acetaminophen)

+

fluphenazine

1 interaction

Monitor/Modify Tx

tramadol + fluphenazine

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• formoterol inhaled
Ultracet (tramadol/ acetaminophen)

+

formoterol inhaled

1 interaction

Monitor/Modify Tx

tramadol + formoterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• fosinopril
Ultracet (tramadol/ acetaminophen)

+

fosinopril

1 interaction

Monitor/Modify Tx

tramadol + fosinopril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• foslevodopa
Ultracet (tramadol/ acetaminophen)

+

foslevodopa

1 interaction

Monitor/Modify Tx

tramadol + foslevodopa

monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• fostemsavir
Ultracet (tramadol/ acetaminophen)

+

fostemsavir

1 interaction

Monitor/Modify Tx

tramadol + fostemsavir

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• furosemide
Ultracet (tramadol/ acetaminophen)

+

furosemide

1 interaction

Monitor/Modify Tx

tramadol + furosemide

monitor sodium, BP: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope; may decr. furosemide efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• gabapentin enacarbil
Ultracet (tramadol/ acetaminophen)

+

gabapentin enacarbil

1 interaction

Monitor/Modify Tx

tramadol + gabapentin enacarbil

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• ganaxolone
Ultracet (tramadol/ acetaminophen)

+

ganaxolone

1 interaction

Monitor/Modify Tx

tramadol + ganaxolone

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• gemfibrozil
Ultracet (tramadol/ acetaminophen)

+

gemfibrozil

1 interaction

Monitor/Modify Tx

acetaminophen + gemfibrozil

consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)

• gemtuzumab ozogamicin
Ultracet (tramadol/ acetaminophen)

+

gemtuzumab ozogamicin

1 interaction

Monitor/Modify Tx

tramadol + gemtuzumab ozogamicin

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• glimepiride
Ultracet (tramadol/ acetaminophen)

+

glimepiride

1 interaction

Monitor/Modify Tx

tramadol + glimepiride

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• glipizide
Ultracet (tramadol/ acetaminophen)

+

glipizide

1 interaction

Monitor/Modify Tx

tramadol + glipizide

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• glofitamab
Ultracet (tramadol/ acetaminophen)

+

glofitamab

1 interaction

Monitor/Modify Tx

tramadol + glofitamab

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• glyburide
Ultracet (tramadol/ acetaminophen)

+

glyburide

1 interaction

Monitor/Modify Tx

tramadol + glyburide

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• glycopyrrolate
Ultracet (tramadol/ acetaminophen)

+

glycopyrrolate

1 interaction

Monitor/Modify Tx

tramadol + glycopyrrolate

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• guanfacine
Ultracet (tramadol/ acetaminophen)

+

guanfacine

1 interaction

Monitor/Modify Tx

tramadol + guanfacine

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• hydrochlorothiazide
Ultracet (tramadol/ acetaminophen)

+

hydrochlorothiazide

1 interaction

Monitor/Modify Tx

tramadol + hydrochlorothiazide

monitor sodium, BP: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope; may decr. hydrochlorothiazide efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• hyoscyamine
Ultracet (tramadol/ acetaminophen)

+

hyoscyamine

2 interactions

Monitor/Modify Tx

tramadol + hyoscyamine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

Caution Advised

acetaminophen + hyoscyamine

caution advised w/ oral acetaminophen: combo may delay analgesic onset, decr. peak acetaminophen levels, efficacy (absorption delayed, possibly decreased)

• ifosfamide
Ultracet (tramadol/ acetaminophen)

+

ifosfamide

1 interaction

Monitor/Modify Tx

tramadol + ifosfamide

monitor sodium, resp. rate; decr. tramadol dose, use lowest effective doses and shortest duration of concomitant tx; D/C one or both drugs if encephalopathy occurs: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hyponatremia, seizures (additive effects)

• iloprost
Ultracet (tramadol/ acetaminophen)

+

iloprost

1 interaction

Monitor/Modify Tx

tramadol + iloprost

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• iloprost inhaled
Ultracet (tramadol/ acetaminophen)

+

iloprost inhaled

1 interaction

Monitor/Modify Tx

tramadol + iloprost inhaled

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• indapamide
Ultracet (tramadol/ acetaminophen)

+

indapamide

1 interaction

Monitor/Modify Tx

tramadol + indapamide

monitor sodium, BP: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope; may decr. indapamide efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• insulin
Ultracet (tramadol/ acetaminophen)

+

insulin

1 interaction

Monitor/Modify Tx

tramadol + insulin

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• iopamidol
Ultracet (tramadol/ acetaminophen)

+

iopamidol

1 interaction

Monitor/Modify Tx

tramadol + iopamidol

caution advised if intrathecal iopamidol use; consider holding tramadol at least 48h before and at least 24h after intrathecal iopamidol: combo may incr. risk of seizures (additive effects)

• irbesartan
Ultracet (tramadol/ acetaminophen)

+

irbesartan

1 interaction

Monitor/Modify Tx

tramadol + irbesartan

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• iron sucrose
Ultracet (tramadol/ acetaminophen)

+

iron sucrose

1 interaction

Monitor/Modify Tx

tramadol + iron sucrose

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• isoflurane
Ultracet (tramadol/ acetaminophen)

+

isoflurane

1 interaction

Monitor/Modify Tx

tramadol + isoflurane

monitor resp. rate, BP, ECG; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• isosorbide dinitrate
Ultracet (tramadol/ acetaminophen)

+

isosorbide dinitrate

1 interaction

Monitor/Modify Tx

tramadol + isosorbide dinitrate

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• isosorbide mononitrate
Ultracet (tramadol/ acetaminophen)

+

isosorbide mononitrate

1 interaction

Monitor/Modify Tx

tramadol + isosorbide mononitrate

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• isradipine
Ultracet (tramadol/ acetaminophen)

+

isradipine

1 interaction

Monitor/Modify Tx

tramadol + isradipine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• ketoprofen
Ultracet (tramadol/ acetaminophen)

+

ketoprofen

1 interaction

Monitor/Modify Tx

acetaminophen + ketoprofen

monitor renal fxn, especially w/ long-term concomitant tx: combo may incr. risk of nephrotoxicity (additive effects)

• lacosamide
Ultracet (tramadol/ acetaminophen)

+

lacosamide

1 interaction

Monitor/Modify Tx

tramadol + lacosamide

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• lamotrigine
Ultracet (tramadol/ acetaminophen)

+

lamotrigine

1 interaction

Monitor/Modify Tx

tramadol + lamotrigine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• landiolol
Ultracet (tramadol/ acetaminophen)

+

landiolol

1 interaction

Monitor/Modify Tx

tramadol + landiolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• lapatinib
Ultracet (tramadol/ acetaminophen)

+

lapatinib

1 interaction

Monitor/Modify Tx

tramadol + lapatinib

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• lemborexant
Ultracet (tramadol/ acetaminophen)

+

lemborexant

1 interaction

Monitor/Modify Tx

tramadol + lemborexant

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• lenvatinib
Ultracet (tramadol/ acetaminophen)

+

lenvatinib

2 interactions

Monitor/Modify Tx

acetaminophen + lenvatinib

consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT possibly inhibited)

tramadol + lenvatinib

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• levalbuterol inhaled
Ultracet (tramadol/ acetaminophen)

+

levalbuterol inhaled

1 interaction

Monitor/Modify Tx

tramadol + levalbuterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• levetiracetam
Ultracet (tramadol/ acetaminophen)

+

levetiracetam

1 interaction

Monitor/Modify Tx

tramadol + levetiracetam

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• levobunolol ophthalmic
Ultracet (tramadol/ acetaminophen)

+

levobunolol ophthalmic

1 interaction

Monitor/Modify Tx

tramadol + levobunolol ophthalmic

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• levocetirizine
Ultracet (tramadol/ acetaminophen)

+

levocetirizine

1 interaction

Monitor/Modify Tx

tramadol + levocetirizine

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• levodopa
Ultracet (tramadol/ acetaminophen)

+

levodopa

1 interaction

Monitor/Modify Tx

tramadol + levodopa

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• lidocaine
Ultracet (tramadol/ acetaminophen)

+

lidocaine

2 interactions

Monitor/Modify Tx

tramadol + lidocaine

monitor BP: combo may incr. risk of severe hypotension (incl. orthostasis, syncope), seizures (additive effects)

Caution Advised

acetaminophen + lidocaine

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• linagliptin
Ultracet (tramadol/ acetaminophen)

+

linagliptin

1 interaction

Monitor/Modify Tx

tramadol + linagliptin

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• linvoseltamab
Ultracet (tramadol/ acetaminophen)

+

linvoseltamab

1 interaction

Monitor/Modify Tx

tramadol + linvoseltamab

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• liraglutide
Ultracet (tramadol/ acetaminophen)

+

liraglutide

2 interactions

Monitor/Modify Tx

tramadol + liraglutide

monitor glucose in type 2 diabetes mellitus pts, consider monitoring glucose in obesity pts: combo may incr. risk of severe hypoglycemia (additive effects)

Caution Advised

acetaminophen + liraglutide

caution advised w/ oral acetaminophen: combo may delay analgesic onset, decr. peak acetaminophen levels, efficacy (absorption delayed, possibly decreased)

• lisinopril
Ultracet (tramadol/ acetaminophen)

+

lisinopril

1 interaction

Monitor/Modify Tx

tramadol + lisinopril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• lixisenatide
Ultracet (tramadol/ acetaminophen)

+

lixisenatide

2 interactions

Monitor/Modify Tx

acetaminophen + lixisenatide

give oral acetaminophen at least 1h before lixisenatide: combo may delay analgesic onset, decr. peak acetaminophen levels, efficacy (absorption delayed, possibly decreased)

tramadol + lixisenatide

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• losartan
Ultracet (tramadol/ acetaminophen)

+

losartan

1 interaction

Monitor/Modify Tx

tramadol + losartan

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• loxapine
Ultracet (tramadol/ acetaminophen)

+

loxapine

1 interaction

Monitor/Modify Tx

tramadol + loxapine

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• lubiprostone
Ultracet (tramadol/ acetaminophen)

+

lubiprostone

1 interaction

Monitor/Modify Tx

tramadol + lubiprostone

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• lumateperone
Ultracet (tramadol/ acetaminophen)

+

lumateperone

1 interaction

Monitor/Modify Tx

tramadol + lumateperone

monitor ECG, BP, resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of QT prolongation, cardiac arrhythmias, profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• lurasidone
Ultracet (tramadol/ acetaminophen)

+

lurasidone

1 interaction

Monitor/Modify Tx

tramadol + lurasidone

monitor ECG, BP, resp. rate; consider lowest lurasidone start dose, titrate slowly: combo may incr. risk of QT prolongation, cardiac arrhythmias, severe hypotension (incl. orthostasis, syncope), profound CNS and resp. depression, psychomotor impairment, seizures (additive effects)

• magnesium citrate
Ultracet (tramadol/ acetaminophen)

+

magnesium citrate

1 interaction

Monitor/Modify Tx

tramadol + magnesium citrate

monitor sodium, especially if magnesium citrate bowel prep use: combo may incr. risk of severe hyponatremia, seizures (additive effects)

• magnesium sulfate
Ultracet (tramadol/ acetaminophen)

+

magnesium sulfate

1 interaction

Monitor/Modify Tx

tramadol + magnesium sulfate

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• mannitol
Ultracet (tramadol/ acetaminophen)

+

mannitol

1 interaction

Monitor/Modify Tx

tramadol + mannitol

monitor sodium, BP; consider incr. mannitol dose: combo may incr. risk of severe hyponatremia (incl. life-threatening), seizures; may decr. mannitol efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• maraviroc
Ultracet (tramadol/ acetaminophen)

+

maraviroc

1 interaction

Monitor/Modify Tx

tramadol + maraviroc

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• meclizine
Ultracet (tramadol/ acetaminophen)

+

meclizine

1 interaction

Monitor/Modify Tx

tramadol + meclizine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• meclofenamate
Ultracet (tramadol/ acetaminophen)

+

meclofenamate

1 interaction

Monitor/Modify Tx

acetaminophen + meclofenamate

monitor renal fxn, especially w/ long-term concomitant tx: combo may incr. risk of nephrotoxicity (additive effects)

• mefenamic acid
Ultracet (tramadol/ acetaminophen)

+

mefenamic acid

1 interaction

Monitor/Modify Tx

acetaminophen + mefenamic acid

monitor renal fxn, especially w/ long-term concomitant tx: combo may incr. risk of nephrotoxicity (additive effects)

• mefloquine
Ultracet (tramadol/ acetaminophen)

+

mefloquine

1 interaction

Monitor/Modify Tx

tramadol + mefloquine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• melatonin
Ultracet (tramadol/ acetaminophen)

+

melatonin

1 interaction

Monitor/Modify Tx

tramadol + melatonin

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures (additive effects)

• mepivacaine
Ultracet (tramadol/ acetaminophen)

+

mepivacaine

2 interactions

Monitor/Modify Tx

tramadol + mepivacaine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

Caution Advised

acetaminophen + mepivacaine

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• meprobamate
Ultracet (tramadol/ acetaminophen)

+

meprobamate

1 interaction

Monitor/Modify Tx

tramadol + meprobamate

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• meropenem
Ultracet (tramadol/ acetaminophen)

+

meropenem

1 interaction

Monitor/Modify Tx

tramadol + meropenem

monitor withdrawal sx: combo may decr. tramadol levels, efficacy; may incr. risk of seizures (hepatic metab. possibly induced; additive effects)

• methazolamide
Ultracet (tramadol/ acetaminophen)

+

methazolamide

1 interaction

Monitor/Modify Tx

tramadol + methazolamide

monitor sodium: combo may incr. risk of severe hyponatremia (additive effects)

• methocarbamol
Ultracet (tramadol/ acetaminophen)

+

methocarbamol

1 interaction

Monitor/Modify Tx

tramadol + methocarbamol

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures (additive effects)

• methsuximide
Ultracet (tramadol/ acetaminophen)

+

methsuximide

1 interaction

Monitor/Modify Tx

tramadol + methsuximide

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• methyldopa
Ultracet (tramadol/ acetaminophen)

+

methyldopa

1 interaction

Monitor/Modify Tx

tramadol + methyldopa

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• metolazone
Ultracet (tramadol/ acetaminophen)

+

metolazone

1 interaction

Monitor/Modify Tx

tramadol + metolazone

monitor sodium, BP: combo may incr. risk of severe hyponatremia (incl. life-threatening), severe hypotension, incl. orthostasis, syncope; may decr. metolazone efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• metoprolol
Ultracet (tramadol/ acetaminophen)

+

metoprolol

1 interaction

Monitor/Modify Tx

tramadol + metoprolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• metronidazole
Ultracet (tramadol/ acetaminophen)

+

metronidazole

1 interaction

Monitor/Modify Tx

tramadol + metronidazole

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• metyrosine
Ultracet (tramadol/ acetaminophen)

+

metyrosine

1 interaction

Monitor/Modify Tx

tramadol + metyrosine

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• midostaurin
Ultracet (tramadol/ acetaminophen)

+

midostaurin

1 interaction

Monitor/Modify Tx

tramadol + midostaurin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• milrinone
Ultracet (tramadol/ acetaminophen)

+

milrinone

1 interaction

Monitor/Modify Tx

tramadol + milrinone

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• minoxidil
Ultracet (tramadol/ acetaminophen)

+

minoxidil

1 interaction

Monitor/Modify Tx

tramadol + minoxidil

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• moexipril
Ultracet (tramadol/ acetaminophen)

+

moexipril

1 interaction

Monitor/Modify Tx

tramadol + moexipril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• molindone
Ultracet (tramadol/ acetaminophen)

+

molindone

1 interaction

Monitor/Modify Tx

tramadol + molindone

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• mosunetuzumab
Ultracet (tramadol/ acetaminophen)

+

mosunetuzumab

1 interaction

Monitor/Modify Tx

tramadol + mosunetuzumab

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• mycophenolate mofetil
Ultracet (tramadol/ acetaminophen)

+

mycophenolate mofetil

1 interaction

Monitor/Modify Tx

tramadol + mycophenolate mofetil

monitor resp. rate; decr. tramadol dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• nabumetone
Ultracet (tramadol/ acetaminophen)

+

nabumetone

1 interaction

Monitor/Modify Tx

acetaminophen + nabumetone

monitor renal fxn, especially w/ long-term concomitant tx: combo may incr. risk of nephrotoxicity (additive effects)

• nadolol
Ultracet (tramadol/ acetaminophen)

+

nadolol

1 interaction

Monitor/Modify Tx

tramadol + nadolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• nateglinide
Ultracet (tramadol/ acetaminophen)

+

nateglinide

1 interaction

Monitor/Modify Tx

tramadol + nateglinide

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• nattokinase
Ultracet (tramadol/ acetaminophen)

+

nattokinase

1 interaction

Monitor/Modify Tx

tramadol + nattokinase

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• naxitamab
Ultracet (tramadol/ acetaminophen)

+

naxitamab

1 interaction

Monitor/Modify Tx

tramadol + naxitamab

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• nebivolol
Ultracet (tramadol/ acetaminophen)

+

nebivolol

1 interaction

Monitor/Modify Tx

tramadol + nebivolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• nelarabine
Ultracet (tramadol/ acetaminophen)

+

nelarabine

1 interaction

Monitor/Modify Tx

tramadol + nelarabine

monitor resp. rate, decr. tramadol dose, use lowest effective doses and shortest duration of concomitant tx; withhold nelarabine if Grade 2 or greater somnolence occurs: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures (additive effects)

• niacin (vitamin B3)
Ultracet (tramadol/ acetaminophen)

+

niacin (vitamin B3)

1 interaction

Monitor/Modify Tx

tramadol + niacin (vitamin B3)

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• nicardipine
Ultracet (tramadol/ acetaminophen)

+

nicardipine

1 interaction

Monitor/Modify Tx

tramadol + nicardipine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• nifedipine
Ultracet (tramadol/ acetaminophen)

+

nifedipine

1 interaction

Monitor/Modify Tx

tramadol + nifedipine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• nimodipine
Ultracet (tramadol/ acetaminophen)

+

nimodipine

1 interaction

Monitor/Modify Tx

tramadol + nimodipine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• nisoldipine
Ultracet (tramadol/ acetaminophen)

+

nisoldipine

1 interaction

Monitor/Modify Tx

tramadol + nisoldipine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• nitisinone
Ultracet (tramadol/ acetaminophen)

+

nitisinone

1 interaction

Monitor/Modify Tx

acetaminophen + nitisinone

caution advised, limit acetaminophen <2 g/day: combo may incr. risk of acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic metabolite formation)

• nitric oxide
Ultracet (tramadol/ acetaminophen)

+

nitric oxide

1 interaction

Monitor/Modify Tx

tramadol + nitric oxide

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• nitrite
Ultracet (tramadol/ acetaminophen)

+

nitrite

2 interactions

Monitor/Modify Tx

acetaminophen + nitrite

monitor methemoglobin levels: combo may incr. risk of methemoglobinemia (additive effects)

tramadol + nitrite

monitor BP: combo may incr. risk of severe or life-threatening hypotension, incl. orthostasis, syncope (additive effects)

• nitroglycerin
Ultracet (tramadol/ acetaminophen)

+

nitroglycerin

1 interaction

Monitor/Modify Tx

tramadol + nitroglycerin

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• nitroprusside
Ultracet (tramadol/ acetaminophen)

+

nitroprusside

2 interactions

Monitor/Modify Tx

tramadol + nitroprusside

monitor BP: combo may incr. risk of severe or life-threatening hypotension, incl. orthostasis, syncope (additive effects)

Caution Advised

acetaminophen + nitroprusside

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• ofloxacin
Ultracet (tramadol/ acetaminophen)

+

ofloxacin

1 interaction

Monitor/Modify Tx

tramadol + ofloxacin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• olanzapine
Ultracet (tramadol/ acetaminophen)

+

olanzapine

1 interaction

Monitor/Modify Tx

tramadol + olanzapine

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus (incl. life-threatening), urinary retention (additive effects)

• olmesartan medoxomil
Ultracet (tramadol/ acetaminophen)

+

olmesartan medoxomil

1 interaction

Monitor/Modify Tx

tramadol + olmesartan medoxomil

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• olodaterol inhaled
Ultracet (tramadol/ acetaminophen)

+

olodaterol inhaled

1 interaction

Monitor/Modify Tx

tramadol + olodaterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• olutasidenib
Ultracet (tramadol/ acetaminophen)

+

olutasidenib

1 interaction

Monitor/Modify Tx

tramadol + olutasidenib

monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. possibly induced)

• opicapone
Ultracet (tramadol/ acetaminophen)

+

opicapone

1 interaction

Monitor/Modify Tx

tramadol + opicapone

monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• orphenadrine
Ultracet (tramadol/ acetaminophen)

+

orphenadrine

1 interaction

Monitor/Modify Tx

tramadol + orphenadrine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• oxybutynin
Ultracet (tramadol/ acetaminophen)

+

oxybutynin

1 interaction

Monitor/Modify Tx

tramadol + oxybutynin

monitor resp. rate; decr. dose of one or both drugs or consider oxybutynin transdermal patch, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention; somnolence less likely w/ oxybutynin transdermal patch (additive effects)

• oxytocin
Ultracet (tramadol/ acetaminophen)

+

oxytocin

1 interaction

Monitor/Modify Tx

tramadol + oxytocin

monitor sodium: combo may incr. risk of severe hyponatremia (additive effects)

• palopegteriparatide
Ultracet (tramadol/ acetaminophen)

+

palopegteriparatide

1 interaction

Monitor/Modify Tx

tramadol + palopegteriparatide

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• pamabrom
Ultracet (tramadol/ acetaminophen)

+

pamabrom

1 interaction

Monitor/Modify Tx

tramadol + pamabrom

monitor BP, consider incr. pamabrom dose: combo may decr. pamabrom efficacy (antagonistic effects, opioids may induce antidiuretic hormone release)

• passion flower
Ultracet (tramadol/ acetaminophen)

+

passion flower

1 interaction

Monitor/Modify Tx

tramadol + passion flower

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• perindopril
Ultracet (tramadol/ acetaminophen)

+

perindopril

1 interaction

Monitor/Modify Tx

tramadol + perindopril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• perphenazine
Ultracet (tramadol/ acetaminophen)

+

perphenazine

1 interaction

Monitor/Modify Tx

tramadol + perphenazine

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• pheniramine
Ultracet (tramadol/ acetaminophen)

+

pheniramine

1 interaction

Monitor/Modify Tx

tramadol + pheniramine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• phenoxybenzamine
Ultracet (tramadol/ acetaminophen)

+

phenoxybenzamine

1 interaction

Monitor/Modify Tx

tramadol + phenoxybenzamine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• phentolamine
Ultracet (tramadol/ acetaminophen)

+

phentolamine

1 interaction

Monitor/Modify Tx

tramadol + phentolamine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• pindolol
Ultracet (tramadol/ acetaminophen)

+

pindolol

1 interaction

Monitor/Modify Tx

tramadol + pindolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• polyethylene glycol
Ultracet (tramadol/ acetaminophen)

+

polyethylene glycol

1 interaction

Monitor/Modify Tx

tramadol + polyethylene glycol

monitor sodium, especially if polyethylene glycol bowel prep use: combo may incr. risk of severe hyponatremia, seizures (additive effects)

• polyethylene glycol/electrolytes
Ultracet (tramadol/ acetaminophen)

+

polyethylene glycol/ electrolytes

1 interaction

Monitor/Modify Tx

tramadol + polyethylene glycol/ electrolytes

monitor sodium: combo may incr. risk of severe hyponatremia, seizures (additive effects)

• pralsetinib
Ultracet (tramadol/ acetaminophen)

+

pralsetinib

1 interaction

Monitor/Modify Tx

tramadol + pralsetinib

monitor ECG; consider monitoring electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• pramipexole
Ultracet (tramadol/ acetaminophen)

+

pramipexole

1 interaction

Monitor/Modify Tx

tramadol + pramipexole

monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• prazosin
Ultracet (tramadol/ acetaminophen)

+

prazosin

1 interaction

Monitor/Modify Tx

tramadol + prazosin

monitor BP, especially during prazosin initiation/titration: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• primaquine
Ultracet (tramadol/ acetaminophen)

+

primaquine

1 interaction

Monitor/Modify Tx

tramadol + primaquine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• probenecid
Ultracet (tramadol/ acetaminophen)

+

probenecid

1 interaction

Monitor/Modify Tx

acetaminophen + probenecid

consider decr. acetaminophen dose: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)

• propofol
Ultracet (tramadol/ acetaminophen)

+

propofol

1 interaction

Monitor/Modify Tx

tramadol + propofol

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• pyrilamine
Ultracet (tramadol/ acetaminophen)

+

pyrilamine

1 interaction

Monitor/Modify Tx

tramadol + pyrilamine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• quinapril
Ultracet (tramadol/ acetaminophen)

+

quinapril

1 interaction

Monitor/Modify Tx

tramadol + quinapril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• ramelteon
Ultracet (tramadol/ acetaminophen)

+

ramelteon

1 interaction

Monitor/Modify Tx

tramadol + ramelteon

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• ramipril
Ultracet (tramadol/ acetaminophen)

+

ramipril

1 interaction

Monitor/Modify Tx

tramadol + ramipril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• ramucirumab
Ultracet (tramadol/ acetaminophen)

+

ramucirumab

1 interaction

Monitor/Modify Tx

tramadol + ramucirumab

monitor sodium: combo may incr. risk of severe hyponatremia (additive effects)

• regorafenib
Ultracet (tramadol/ acetaminophen)

+

regorafenib

1 interaction

Monitor/Modify Tx

acetaminophen + regorafenib

consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)

• relugolix
Ultracet (tramadol/ acetaminophen)

+

relugolix

1 interaction

Monitor/Modify Tx

tramadol + relugolix

if prostate cancer use, monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• repaglinide
Ultracet (tramadol/ acetaminophen)

+

repaglinide

1 interaction

Monitor/Modify Tx

tramadol + repaglinide

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• riociguat
Ultracet (tramadol/ acetaminophen)

+

riociguat

1 interaction

Monitor/Modify Tx

tramadol + riociguat

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• risperidone
Ultracet (tramadol/ acetaminophen)

+

risperidone

1 interaction

Monitor/Modify Tx

tramadol + risperidone

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension, incl. orthostasis, syncope (additive effects)

• rocuronium
Ultracet (tramadol/ acetaminophen)

+

rocuronium

1 interaction

Monitor/Modify Tx

tramadol + rocuronium

monitor resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of resp. depression, potentiate, prolong neuromuscular blockade (additive effects)

• ropinirole
Ultracet (tramadol/ acetaminophen)

+

ropinirole

1 interaction

Monitor/Modify Tx

tramadol + ropinirole

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• ropivacaine
Ultracet (tramadol/ acetaminophen)

+

ropivacaine

2 interactions

Monitor/Modify Tx

tramadol + ropivacaine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

Caution Advised

acetaminophen + ropivacaine

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• rosiglitazone
Ultracet (tramadol/ acetaminophen)

+

rosiglitazone

1 interaction

Monitor/Modify Tx

tramadol + rosiglitazone

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• rotigotine transdermal
Ultracet (tramadol/ acetaminophen)

+

rotigotine transdermal

1 interaction

Monitor/Modify Tx

tramadol + rotigotine transdermal

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• sacituzumab govitecan
Ultracet (tramadol/ acetaminophen)

+

sacituzumab govitecan

1 interaction

Monitor/Modify Tx

tramadol + sacituzumab govitecan

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• sacubitril
Ultracet (tramadol/ acetaminophen)

+

sacubitril

1 interaction

Monitor/Modify Tx

tramadol + sacubitril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• salmeterol inhaled
Ultracet (tramadol/ acetaminophen)

+

salmeterol inhaled

1 interaction

Monitor/Modify Tx

tramadol + salmeterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• salsalate
Ultracet (tramadol/ acetaminophen)

+

salsalate

1 interaction

Monitor/Modify Tx

acetaminophen + salsalate

monitor renal fxn, especially w/ long-term concomitant tx: combo may incr. risk of nephrotoxicity (additive effects)

• saxagliptin
Ultracet (tramadol/ acetaminophen)

+

saxagliptin

1 interaction

Monitor/Modify Tx

tramadol + saxagliptin

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• scopolamine
Ultracet (tramadol/ acetaminophen)

+

scopolamine

1 interaction

Monitor/Modify Tx

tramadol + scopolamine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe constipation, paralytic ileus, urinary retention (additive effects)

• selinexor
Ultracet (tramadol/ acetaminophen)

+

selinexor

1 interaction

Monitor/Modify Tx

tramadol + selinexor

monitor sodium, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hyponatremia, incl. life-threatening (additive effects)

• semaglutide
Ultracet (tramadol/ acetaminophen)

+

semaglutide

1 interaction

Monitor/Modify Tx

tramadol + semaglutide

monitor glucose in type 2 diabetes mellitus pts; consider monitoring glucose in obesity pts: combo may incr. risk of severe hypoglycemia (additive effects)

• sevoflurane
Ultracet (tramadol/ acetaminophen)

+

sevoflurane

1 interaction

Monitor/Modify Tx

tramadol + sevoflurane

monitor resp. rate, ECG, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• sildenafil
Ultracet (tramadol/ acetaminophen)

+

sildenafil

1 interaction

Monitor/Modify Tx

tramadol + sildenafil

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• silodosin
Ultracet (tramadol/ acetaminophen)

+

silodosin

1 interaction

Monitor/Modify Tx

tramadol + silodosin

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• sitagliptin
Ultracet (tramadol/ acetaminophen)

+

sitagliptin

1 interaction

Monitor/Modify Tx

tramadol + sitagliptin

monitor glucose: combo may incr. risk of severe hypoglycemia (additive effects)

• sodium ferric gluconate complex
Ultracet (tramadol/ acetaminophen)

+

sodium ferric gluconate complex

1 interaction

Monitor/Modify Tx

tramadol + sodium ferric gluconate complex

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• sotagliflozin
Ultracet (tramadol/ acetaminophen)

+

sotagliflozin

1 interaction

Monitor/Modify Tx

tramadol + sotagliflozin

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• sparsentan
Ultracet (tramadol/ acetaminophen)

+

sparsentan

1 interaction

Monitor/Modify Tx

tramadol + sparsentan

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• spironolactone
Ultracet (tramadol/ acetaminophen)

+

spironolactone

1 interaction

Monitor/Modify Tx

tramadol + spironolactone

monitor sodium, BP: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope; may decr. spironolactone efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• stiripentol
Ultracet (tramadol/ acetaminophen)

+

stiripentol

1 interaction

Monitor/Modify Tx

tramadol + stiripentol

monitor withdrawal sx, resp. rate; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. possibly induced; additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• succinylcholine
Ultracet (tramadol/ acetaminophen)

+

succinylcholine

1 interaction

Monitor/Modify Tx

tramadol + succinylcholine

monitor resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of resp. depression, potentiate, prolong neuromuscular blockade (additive effects)

• sulfate bowel prep
Ultracet (tramadol/ acetaminophen)

+

sulfate bowel prep

1 interaction

Monitor/Modify Tx

tramadol + sulfate bowel prep

monitor sodium: combo may incr. risk of severe hyponatremia, seizures (additive effects)

• sulindac
Ultracet (tramadol/ acetaminophen)

+

sulindac

1 interaction

Monitor/Modify Tx

acetaminophen + sulindac

monitor renal fxn, especially w/ long-term concomitant tx: combo may incr. risk of nephrotoxicity (additive effects)

• sunitinib
Ultracet (tramadol/ acetaminophen)

+

sunitinib

1 interaction

Monitor/Modify Tx

tramadol + sunitinib

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• suvorexant
Ultracet (tramadol/ acetaminophen)

+

suvorexant

1 interaction

Monitor/Modify Tx

tramadol + suvorexant

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• tacrolimus
Ultracet (tramadol/ acetaminophen)

+

tacrolimus

1 interaction

Monitor/Modify Tx

tramadol + tacrolimus

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• tadalafil
Ultracet (tramadol/ acetaminophen)

+

tadalafil

1 interaction

Monitor/Modify Tx

tramadol + tadalafil

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• tagraxofusp
Ultracet (tramadol/ acetaminophen)

+

tagraxofusp

1 interaction

Monitor/Modify Tx

tramadol + tagraxofusp

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• tamsulosin
Ultracet (tramadol/ acetaminophen)

+

tamsulosin

1 interaction

Monitor/Modify Tx

tramadol + tamsulosin

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• tasimelteon
Ultracet (tramadol/ acetaminophen)

+

tasimelteon

1 interaction

Monitor/Modify Tx

tramadol + tasimelteon

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• taurine
Ultracet (tramadol/ acetaminophen)

+

taurine

1 interaction

Monitor/Modify Tx

tramadol + taurine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• telmisartan
Ultracet (tramadol/ acetaminophen)

+

telmisartan

1 interaction

Monitor/Modify Tx

tramadol + telmisartan

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• terazosin
Ultracet (tramadol/ acetaminophen)

+

terazosin

1 interaction

Monitor/Modify Tx

tramadol + terazosin

monitor BP, especially during terazosin initiation/titration: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• terbutaline
Ultracet (tramadol/ acetaminophen)

+

terbutaline

1 interaction

Monitor/Modify Tx

tramadol + terbutaline

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• thiotepa
Ultracet (tramadol/ acetaminophen)

+

thiotepa

1 interaction

Monitor/Modify Tx

tramadol + thiotepa

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures (additive effects)

• thiothixene
Ultracet (tramadol/ acetaminophen)

+

thiothixene

1 interaction

Monitor/Modify Tx

tramadol + thiothixene

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, severe constipation, paralytic ileus, urinary retention (additive effects)

• tiagabine
Ultracet (tramadol/ acetaminophen)

+

tiagabine

1 interaction

Monitor/Modify Tx

tramadol + tiagabine

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• timolol
Ultracet (tramadol/ acetaminophen)

+

timolol

1 interaction

Monitor/Modify Tx

tramadol + timolol

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• timolol ophthalmic
Ultracet (tramadol/ acetaminophen)

+

timolol ophthalmic

1 interaction

Monitor/Modify Tx

tramadol + timolol ophthalmic

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• tizanidine
Ultracet (tramadol/ acetaminophen)

+

tizanidine

1 interaction

Monitor/Modify Tx

tramadol + tizanidine

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• tolcapone
Ultracet (tramadol/ acetaminophen)

+

tolcapone

1 interaction

Monitor/Modify Tx

tramadol + tolcapone

monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)

• tolmetin
Ultracet (tramadol/ acetaminophen)

+

tolmetin

1 interaction

Monitor/Modify Tx

acetaminophen + tolmetin

monitor renal fxn, especially w/ long-term concomitant tx: combo may incr. risk of nephrotoxicity (additive effects)

• tolterodine
Ultracet (tramadol/ acetaminophen)

+

tolterodine

1 interaction

Monitor/Modify Tx

tramadol + tolterodine

monitor resp. rate, ECG; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, severe constipation, paralytic ileus, urinary retention (additive effects)

• torsemide
Ultracet (tramadol/ acetaminophen)

+

torsemide

1 interaction

Monitor/Modify Tx

tramadol + torsemide

monitor sodium, BP: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope; may decr. torsemide efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• trandolapril
Ultracet (tramadol/ acetaminophen)

+

trandolapril

1 interaction

Monitor/Modify Tx

tramadol + trandolapril

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• treprostinil
Ultracet (tramadol/ acetaminophen)

+

treprostinil

1 interaction

Monitor/Modify Tx

tramadol + treprostinil

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• triamterene
Ultracet (tramadol/ acetaminophen)

+

triamterene

1 interaction

Monitor/Modify Tx

tramadol + triamterene

monitor sodium, BP: combo may incr. risk of severe hyponatremia, severe hypotension, incl. orthostasis, syncope; may decr. triamterene efficacy (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)

• trifluoperazine
Ultracet (tramadol/ acetaminophen)

+

trifluoperazine

1 interaction

Monitor/Modify Tx

tramadol + trifluoperazine

monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)

• trihexyphenidyl
Ultracet (tramadol/ acetaminophen)

+

trihexyphenidyl

1 interaction

Monitor/Modify Tx

tramadol + trihexyphenidyl

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• trimethobenzamide
Ultracet (tramadol/ acetaminophen)

+

trimethobenzamide

1 interaction

Monitor/Modify Tx

tramadol + trimethobenzamide

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• triprolidine
Ultracet (tramadol/ acetaminophen)

+

triprolidine

1 interaction

Monitor/Modify Tx

tramadol + triprolidine

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• trospium
Ultracet (tramadol/ acetaminophen)

+

trospium

1 interaction

Monitor/Modify Tx

tramadol + trospium

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)

• vaborbactam
Ultracet (tramadol/ acetaminophen)

+

vaborbactam

1 interaction

Monitor/Modify Tx

tramadol + vaborbactam

monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. possibly induced)

• valbenazine
Ultracet (tramadol/ acetaminophen)

+

valbenazine

1 interaction

Monitor/Modify Tx

tramadol + valbenazine

monitor ECG, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of QT prolongation, cardiac arrhythmias, profound CNS and resp. depression, psychomotor impairment (additive effects)

• valerian
Ultracet (tramadol/ acetaminophen)

+

valerian

1 interaction

Monitor/Modify Tx

tramadol + valerian

monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• valproic acid
Ultracet (tramadol/ acetaminophen)

+

valproic acid

1 interaction

Monitor/Modify Tx

tramadol + valproic acid

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• valsartan
Ultracet (tramadol/ acetaminophen)

+

valsartan

1 interaction

Monitor/Modify Tx

tramadol + valsartan

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• vamorolone
Ultracet (tramadol/ acetaminophen)

+

vamorolone

1 interaction

Monitor/Modify Tx

tramadol + vamorolone

monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. possibly induced)

• vardenafil
Ultracet (tramadol/ acetaminophen)

+

vardenafil

1 interaction

Monitor/Modify Tx

tramadol + vardenafil

monitor ECG, BP: combo may incr. risk of QT prolongation, cardiac arrhythmias, severe hypotension, incl. orthostasis, syncope (additive effects)

• vasopressin
Ultracet (tramadol/ acetaminophen)

+

vasopressin

1 interaction

Monitor/Modify Tx

tramadol + vasopressin

monitor sodium: combo may incr. risk of severe hyponatremia (additive effects)

• vecuronium
Ultracet (tramadol/ acetaminophen)

+

vecuronium

1 interaction

Monitor/Modify Tx

tramadol + vecuronium

monitor resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of resp. depression, potentiate, prolong neuromuscular blockade (additive effects)

• vigabatrin
Ultracet (tramadol/ acetaminophen)

+

vigabatrin

1 interaction

Monitor/Modify Tx

tramadol + vigabatrin

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

• vilanterol inhaled
Ultracet (tramadol/ acetaminophen)

+

vilanterol inhaled

1 interaction

Monitor/Modify Tx

tramadol + vilanterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• voclosporin
Ultracet (tramadol/ acetaminophen)

+

voclosporin

1 interaction

Monitor/Modify Tx

tramadol + voclosporin

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• vorasidenib
Ultracet (tramadol/ acetaminophen)

+

vorasidenib

1 interaction

Monitor/Modify Tx

tramadol + vorasidenib

monitor withdrawal sx: combo may decr. tramadol levels, efficacy (hepatic metab. possibly induced)

• vosoritide
Ultracet (tramadol/ acetaminophen)

+

vosoritide

1 interaction

Monitor/Modify Tx

tramadol + vosoritide

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

• warfarin
Ultracet (tramadol/ acetaminophen)

+

warfarin

2 interactions

Monitor/Modify Tx

acetaminophen + warfarin

monitor INR, bleeding s/sx, esp. w/ chronic acetaminophen use >4000 mg/day: combo may incr. risk of bleeding, incl. life-threatening (mechanism unknown)

tramadol + warfarin

monitor INR, bleeding s/sx: combo may incr. risk of bleeding, incl. life-threatening (mechanism unknown)

• zaleplon
Ultracet (tramadol/ acetaminophen)

+

zaleplon

1 interaction

Monitor/Modify Tx

tramadol + zaleplon

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• ziconotide
Ultracet (tramadol/ acetaminophen)

+

ziconotide

1 interaction

Monitor/Modify Tx

tramadol + ziconotide

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, confusion, dizziness, seizures, other CNS adverse effects (additive effects)

• zolpidem
Ultracet (tramadol/ acetaminophen)

+

zolpidem

1 interaction

Monitor/Modify Tx

tramadol + zolpidem

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)

• zonisamide
Ultracet (tramadol/ acetaminophen)

+

zonisamide

1 interaction

Monitor/Modify Tx

tramadol + zonisamide

monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, tramadol may decr. seizure threshold)

Caution Advised

• aclidinium inhaled
Ultracet (tramadol/ acetaminophen)

+

aclidinium inhaled

1 interaction

Caution Advised

tramadol + aclidinium inhaled

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• acyclovir
Ultracet (tramadol/ acetaminophen)

+

acyclovir

1 interaction

Caution Advised

tramadol + acyclovir

caution advised: combo may incr. risk of seizures (additive effects)

• alosetron
Ultracet (tramadol/ acetaminophen)

+

alosetron

1 interaction

Caution Advised

tramadol + alosetron

caution advised: combo may incr. risk of severe constipation, paralytic ileus (additive effects)

• aminophylline
Ultracet (tramadol/ acetaminophen)

+

aminophylline

1 interaction

Caution Advised

tramadol + aminophylline

caution advised: combo may incr. risk of seizures (additive effects)

• amoxicillin
Ultracet (tramadol/ acetaminophen)

+

amoxicillin

1 interaction

Caution Advised

tramadol + amoxicillin

caution advised, especially w/ high amoxicillin doses or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• ampicillin
Ultracet (tramadol/ acetaminophen)

+

ampicillin

1 interaction

Caution Advised

tramadol + ampicillin

caution advised, especially w/ high ampicillin doses or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• atropine
Ultracet (tramadol/ acetaminophen)

+

atropine

1 interaction

Caution Advised

tramadol + atropine

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• axicabtagene ciloleucel
Ultracet (tramadol/ acetaminophen)

+

axicabtagene ciloleucel

1 interaction

Caution Advised

tramadol + axicabtagene ciloleucel

caution advised: combo may incr. risk of seizures (additive effects)

• barium
Ultracet (tramadol/ acetaminophen)

+

barium

1 interaction

Caution Advised

tramadol + barium

caution advised: combo may incr. risk of intestinal obstruction (additive effects)

• belladonna alkaloids
Ultracet (tramadol/ acetaminophen)

+

belladonna alkaloids

1 interaction

Caution Advised

tramadol + belladonna alkaloids

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• benzocaine topical
Ultracet (tramadol/ acetaminophen)

+

benzocaine topical

1 interaction

Caution Advised

acetaminophen + benzocaine topical

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• benzphetamine
Ultracet (tramadol/ acetaminophen)

+

benzphetamine

1 interaction

Caution Advised

tramadol + benzphetamine

caution advised: combo may incr. risk of seizures (additive effects)

• betamethasone
Ultracet (tramadol/ acetaminophen)

+

betamethasone

1 interaction

Caution Advised

tramadol + betamethasone

caution advised: combo may incr. risk of seizures (additive effects)

• botulinum toxin
Ultracet (tramadol/ acetaminophen)

+

botulinum toxin

1 interaction

Caution Advised

tramadol + botulinum toxin

caution advised: combo may incr. risk of urinary retention (additive effects)

• brexucabtagene autoleucel
Ultracet (tramadol/ acetaminophen)

+

brexucabtagene autoleucel

1 interaction

Caution Advised

tramadol + brexucabtagene autoleucel

caution advised: combo may incr. risk of seizures (additive effects)

• busulfan
Ultracet (tramadol/ acetaminophen)

+

busulfan

2 interactions

Caution Advised

acetaminophen + busulfan

caution advised w/ acetaminophen use w/in 72h of busulfan admin.: combo may incr. busulfan levels, risk of serious infection, myelosuppression, other adverse effects (clearance decreased, glutathione depleted by acetaminophen)

tramadol + busulfan

caution advised: combo may incr. risk of seizures (additive effects)

• butamben
Ultracet (tramadol/ acetaminophen)

+

butamben

1 interaction

Caution Advised

acetaminophen + butamben

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• cefazolin
Ultracet (tramadol/ acetaminophen)

+

cefazolin

1 interaction

Caution Advised

tramadol + cefazolin

caution advised, especially w/ high cefazolin doses and/or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• cefepime
Ultracet (tramadol/ acetaminophen)

+

cefepime

1 interaction

Caution Advised

tramadol + cefepime

caution advised, especially w/ high cefepime doses and/or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• cefiderocol
Ultracet (tramadol/ acetaminophen)

+

cefiderocol

1 interaction

Caution Advised

tramadol + cefiderocol

caution advised, especially w/ high cefiderocol doses and/or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• ceftaroline
Ultracet (tramadol/ acetaminophen)

+

ceftaroline

1 interaction

Caution Advised

tramadol + ceftaroline

caution advised, especially w/ high ceftaroline doses and/or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• ceftazidime
Ultracet (tramadol/ acetaminophen)

+

ceftazidime

1 interaction

Caution Advised

tramadol + ceftazidime

caution advised, especially w/ high ceftazidime doses and/or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• ceftobiprole
Ultracet (tramadol/ acetaminophen)

+

ceftobiprole

1 interaction

Caution Advised

tramadol + ceftobiprole

caution advised, especially w/ high ceftobiprole doses and/or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• chlorambucil
Ultracet (tramadol/ acetaminophen)

+

chlorambucil

1 interaction

Caution Advised

tramadol + chlorambucil

caution advised: combo may incr. risk of seizures (additive effects)

• ciltacabtagene autoleucel
Ultracet (tramadol/ acetaminophen)

+

ciltacabtagene autoleucel

1 interaction

Caution Advised

tramadol + ciltacabtagene autoleucel

caution advised: combo may incr. risk of seizures (additive effects)

• clidinium
Ultracet (tramadol/ acetaminophen)

+

clidinium

1 interaction

Caution Advised

tramadol + clidinium

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• cortisone
Ultracet (tramadol/ acetaminophen)

+

cortisone

1 interaction

Caution Advised

tramadol + cortisone

caution advised: combo may incr. risk of seizures (additive effects)

• cycloserine
Ultracet (tramadol/ acetaminophen)

+

cycloserine

1 interaction

Caution Advised

tramadol + cycloserine

caution advised, especially w/ cycloserine daily doses >500 mg and/or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• dalfampridine
Ultracet (tramadol/ acetaminophen)

+

dalfampridine

1 interaction

Caution Advised

tramadol + dalfampridine

caution advised: combo may incr. risk of seizures (additive effects)

• dapsone topical
Ultracet (tramadol/ acetaminophen)

+

dapsone topical

1 interaction

Caution Advised

acetaminophen + dapsone topical

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• darbepoetin alfa
Ultracet (tramadol/ acetaminophen)

+

darbepoetin alfa

1 interaction

Caution Advised

tramadol + darbepoetin alfa

caution advised: combo may incr. risk of seizures (additive effects)

• deflazacort
Ultracet (tramadol/ acetaminophen)

+

deflazacort

1 interaction

Caution Advised

tramadol + deflazacort

caution advised: combo may incr. risk of seizures (additive effects)

• delafloxacin
Ultracet (tramadol/ acetaminophen)

+

delafloxacin

1 interaction

Caution Advised

tramadol + delafloxacin

caution advised: combo may incr. risk of seizures (additive effects)

• dicyclomine
Ultracet (tramadol/ acetaminophen)

+

dicyclomine

1 interaction

Caution Advised

tramadol + dicyclomine

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• diethylpropion
Ultracet (tramadol/ acetaminophen)

+

diethylpropion

1 interaction

Caution Advised

tramadol + diethylpropion

caution advised: combo may incr. risk of seizures (additive effects)

• diflunisal
Ultracet (tramadol/ acetaminophen)

+

diflunisal

1 interaction

Caution Advised

acetaminophen + diflunisal

caution advised: combo may incr. risk of acetaminophen levels, risk of adverse effects (mechanism unknown)

• dulaglutide
Ultracet (tramadol/ acetaminophen)

+

dulaglutide

1 interaction

Caution Advised

acetaminophen + dulaglutide

caution advised w/ oral acetaminophen: combo may delay analgesic onset, decr. peak acetaminophen levels, efficacy (absorption delayed, possibly decreased)

• elivaldogene autotemcel
Ultracet (tramadol/ acetaminophen)

+

elivaldogene autotemcel

1 interaction

Caution Advised

tramadol + elivaldogene autotemcel

caution advised: combo may incr. risk of seizures (additive effects)

• epoetin alfa
Ultracet (tramadol/ acetaminophen)

+

epoetin alfa

1 interaction

Caution Advised

tramadol + epoetin alfa

caution advised: combo may incr. risk of seizures (additive effects)

• erenumab
Ultracet (tramadol/ acetaminophen)

+

erenumab

1 interaction

Caution Advised

tramadol + erenumab

caution advised: combo may incr. risk of severe constipation, paralytic ileus (additive effects)

• ertapenem
Ultracet (tramadol/ acetaminophen)

+

ertapenem

1 interaction

Caution Advised

tramadol + ertapenem

caution advised: combo may incr. risk of seizures (additive effects)

• flavoxate
Ultracet (tramadol/ acetaminophen)

+

flavoxate

1 interaction

Caution Advised

tramadol + flavoxate

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• galantamine
Ultracet (tramadol/ acetaminophen)

+

galantamine

1 interaction

Caution Advised

tramadol + galantamine

caution advised: combo may incr. risk of seizures (additive effects)

• ganciclovir
Ultracet (tramadol/ acetaminophen)

+

ganciclovir

1 interaction

Caution Advised

tramadol + ganciclovir

caution advised: combo may incr. risk of seizures (additive effects)

• glutathione
Ultracet (tramadol/ acetaminophen)

+

glutathione

1 interaction

Caution Advised

acetaminophen + glutathione

caution advised: combo may decr. glutathione efficacy (glutathione depleted by acetaminophen)

• glycopyrrolate inhaled
Ultracet (tramadol/ acetaminophen)

+

glycopyrrolate inhaled

1 interaction

Caution Advised

tramadol + glycopyrrolate inhaled

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• glycopyrronium topical
Ultracet (tramadol/ acetaminophen)

+

glycopyrronium topical

1 interaction

Caution Advised

tramadol + glycopyrronium topical

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• homatropine
Ultracet (tramadol/ acetaminophen)

+

homatropine

1 interaction

Caution Advised

tramadol + homatropine

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• hydrocortisone
Ultracet (tramadol/ acetaminophen)

+

hydrocortisone

1 interaction

Caution Advised

tramadol + hydrocortisone

caution advised: combo may incr. risk of seizures (additive effects)

• idecabtagene vicleucel
Ultracet (tramadol/ acetaminophen)

+

idecabtagene vicleucel

1 interaction

Caution Advised

tramadol + idecabtagene vicleucel

caution advised: combo may incr. risk of seizures (additive effects)

• imipenem
Ultracet (tramadol/ acetaminophen)

+

imipenem

1 interaction

Caution Advised

tramadol + imipenem

caution advised: combo may incr. risk of seizures (additive effects)

• interferon beta 1a
Ultracet (tramadol/ acetaminophen)

+

interferon beta 1a

1 interaction

Caution Advised

tramadol + interferon beta 1a

caution advised: combo may incr. risk of seizures (additive effects)

• interferon beta 1b
Ultracet (tramadol/ acetaminophen)

+

interferon beta 1b

1 interaction

Caution Advised

tramadol + interferon beta 1b

caution advised: combo may incr. risk of seizures (additive effects)

• ipratropium inhaled
Ultracet (tramadol/ acetaminophen)

+

ipratropium inhaled

1 interaction

Caution Advised

tramadol + ipratropium inhaled

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• levocarnitine
Ultracet (tramadol/ acetaminophen)

+

levocarnitine

1 interaction

Caution Advised

tramadol + levocarnitine

caution advised: combo may incr. risk of seizures (additive effects)

• lisocabtagene maraleucel
Ultracet (tramadol/ acetaminophen)

+

lisocabtagene maraleucel

1 interaction

Caution Advised

tramadol + lisocabtagene maraleucel

caution advised: combo may incr. risk of seizures (additive effects)

• methotrexate
Ultracet (tramadol/ acetaminophen)

+

methotrexate

1 interaction

Caution Advised

tramadol + methotrexate

caution advised: combo may incr. risk of seizures (additive effects)

• methoxy polyethylene glycol-epoetin beta
Ultracet (tramadol/ acetaminophen)

+

methoxy polyethylene glycol-epoetin beta

1 interaction

Caution Advised

tramadol + methoxy polyethylene glycol-epoetin beta

caution advised: combo may incr. risk of seizures (additive effects)

• methscopolamine
Ultracet (tramadol/ acetaminophen)

+

methscopolamine

1 interaction

Caution Advised

tramadol + methscopolamine

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• methylprednisolone
Ultracet (tramadol/ acetaminophen)

+

methylprednisolone

1 interaction

Caution Advised

tramadol + methylprednisolone

caution advised: combo may incr. risk of seizures (additive effects)

• mexiletine
Ultracet (tramadol/ acetaminophen)

+

mexiletine

1 interaction

Caution Advised

tramadol + mexiletine

caution advised: combo may delay antiarrhythmic onset, decr. peak mexiletine levels, efficacy; may incr. risk of seizures (absorption delayed; additive effects)

• nafarelin
Ultracet (tramadol/ acetaminophen)

+

nafarelin

1 interaction

Caution Advised

tramadol + nafarelin

caution advised: combo may incr. risk of seizures (additive effects)

• obecabtagene autoleucel
Ultracet (tramadol/ acetaminophen)

+

obecabtagene autoleucel

1 interaction

Caution Advised

tramadol + obecabtagene autoleucel

caution advised: combo may incr. risk of seizures (additive effects)

• oxacillin
Ultracet (tramadol/ acetaminophen)

+

oxacillin

1 interaction

Caution Advised

tramadol + oxacillin

caution advised, especially w/ high oxacillin doses or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• peginterferon beta 1a
Ultracet (tramadol/ acetaminophen)

+

peginterferon beta 1a

1 interaction

Caution Advised

tramadol + peginterferon beta 1a

caution advised: combo may incr. risk of seizures (additive effects)

• penicillin G
Ultracet (tramadol/ acetaminophen)

+

penicillin G

1 interaction

Caution Advised

tramadol + penicillin G

caution advised, especially w/ high penicillin G doses or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• penicillin V
Ultracet (tramadol/ acetaminophen)

+

penicillin V

1 interaction

Caution Advised

tramadol + penicillin V

caution advised, especially w/ high penicillin V doses or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• phenazopyridine
Ultracet (tramadol/ acetaminophen)

+

phenazopyridine

1 interaction

Caution Advised

acetaminophen + phenazopyridine

caution advised: combo may incr. risk of acetaminophen toxicity (duplicate ingredients, phenazopyridine active metabolite is acetaminophen)

• phendimetrazine
Ultracet (tramadol/ acetaminophen)

+

phendimetrazine

1 interaction

Caution Advised

tramadol + phendimetrazine

caution advised: combo may incr. risk of seizures (additive effects)

• phentermine
Ultracet (tramadol/ acetaminophen)

+

phentermine

1 interaction

Caution Advised

tramadol + phentermine

caution advised: combo may incr. risk of seizures (additive effects)

• piperacillin
Ultracet (tramadol/ acetaminophen)

+

piperacillin

1 interaction

Caution Advised

tramadol + piperacillin

caution advised, especially w/ high piperacillin doses or concomitant renal impairment: combo may incr. risk of seizures (additive effects)

• potassium acid phosphate
Ultracet (tramadol/ acetaminophen)

+

potassium acid phosphate

1 interaction

Caution Advised

tramadol + potassium acid phosphate

caution advised w/ solid potassium formulations; liquid potassium formulations OK: combo may incr. risk of GI ulcerative, stenotic lesions (GI transit delayed, increased local exposure to high potassium concentration)

• potassium gluconate
Ultracet (tramadol/ acetaminophen)

+

potassium gluconate

1 interaction

Caution Advised

tramadol + potassium gluconate

caution advised w/ solid potassium formulations; liquid potassium formulations OK: combo may incr. risk of GI ulcerative, stenotic lesions (GI transit delayed, increased local exposure to high potassium concentration)

• potassium phosphate
Ultracet (tramadol/ acetaminophen)

+

potassium phosphate

1 interaction

Caution Advised

tramadol + potassium phosphate

caution advised w/ solid potassium formulations; liquid potassium formulations OK: combo may incr. risk of GI ulcerative, stenotic lesions (GI transit delayed, increased local exposure to high potassium concentration)

• prednisolone
Ultracet (tramadol/ acetaminophen)

+

prednisolone

1 interaction

Caution Advised

tramadol + prednisolone

caution advised: combo may incr. risk of seizures (additive effects)

• procaine
Ultracet (tramadol/ acetaminophen)

+

procaine

1 interaction

Caution Advised

acetaminophen + procaine

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• pyridostigmine
Ultracet (tramadol/ acetaminophen)

+

pyridostigmine

1 interaction

Caution Advised

tramadol + pyridostigmine

caution advised: combo may incr. risk of seizures (additive effects)

• pyrimethamine
Ultracet (tramadol/ acetaminophen)

+

pyrimethamine

1 interaction

Caution Advised

tramadol + pyrimethamine

caution advised: combo may incr. risk of seizures (additive effects)

• regadenoson
Ultracet (tramadol/ acetaminophen)

+

regadenoson

1 interaction

Caution Advised

tramadol + regadenoson

caution advised: combo may incr. risk of seizures (additive effects)

• rivastigmine
Ultracet (tramadol/ acetaminophen)

+

rivastigmine

1 interaction

Caution Advised

tramadol + rivastigmine

caution advised: combo may incr. risk of seizures (additive effects)

• sodium picosulfate
Ultracet (tramadol/ acetaminophen)

+

sodium picosulfate

1 interaction

Caution Advised

tramadol + sodium picosulfate

caution advised: combo may incr. risk of seizures (additive effects)

• sofpironium topical
Ultracet (tramadol/ acetaminophen)

+

sofpironium topical

1 interaction

Caution Advised

tramadol + sofpironium topical

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• tafenoquine
Ultracet (tramadol/ acetaminophen)

+

tafenoquine

1 interaction

Caution Advised

acetaminophen + tafenoquine

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• teclistamab
Ultracet (tramadol/ acetaminophen)

+

teclistamab

1 interaction

Caution Advised

tramadol + teclistamab

caution advised: combo may incr. risk of seizures (additive effects)

• tetracaine
Ultracet (tramadol/ acetaminophen)

+

tetracaine

1 interaction

Caution Advised

acetaminophen + tetracaine

caution advised: combo may incr. risk of methemoglobinemia (additive effects)

• theophylline
Ultracet (tramadol/ acetaminophen)

+

theophylline

1 interaction

Caution Advised

tramadol + theophylline

caution advised: combo may incr. risk of seizures (additive effects)

• tinidazole
Ultracet (tramadol/ acetaminophen)

+

tinidazole

1 interaction

Caution Advised

tramadol + tinidazole

caution advised: combo may incr. risk of seizures (additive effects)

• tiotropium inhaled
Ultracet (tramadol/ acetaminophen)

+

tiotropium inhaled

1 interaction

Caution Advised

tramadol + tiotropium inhaled

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• tirzepatide
Ultracet (tramadol/ acetaminophen)

+

tirzepatide

1 interaction

Caution Advised

acetaminophen + tirzepatide

caution advised w/ oral acetaminophen: combo may delay analgesic onset, decr. peak acetaminophen levels, efficacy (absorption delayed, possibly decreased)

• tisagenlecleucel
Ultracet (tramadol/ acetaminophen)

+

tisagenlecleucel

1 interaction

Caution Advised

tramadol + tisagenlecleucel

caution advised: combo may incr. risk of seizures (additive effects)

• tranexamic acid
Ultracet (tramadol/ acetaminophen)

+

tranexamic acid

1 interaction

Caution Advised

tramadol + tranexamic acid

caution advised, especially w/ high-dose IV tranexamic acid: combo may incr. risk of seizures (additive effects)

• treosulfan
Ultracet (tramadol/ acetaminophen)

+

treosulfan

1 interaction

Caution Advised

tramadol + treosulfan

caution advised: combo may incr. risk of seizures (additive effects)

• triamcinolone
Ultracet (tramadol/ acetaminophen)

+

triamcinolone

1 interaction

Caution Advised

tramadol + triamcinolone

caution advised: combo may incr. risk of seizures (additive effects)

• umeclidinium inhaled
Ultracet (tramadol/ acetaminophen)

+

umeclidinium inhaled

1 interaction

Caution Advised

tramadol + umeclidinium inhaled

caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)

• vadadustat
Ultracet (tramadol/ acetaminophen)

+

vadadustat

1 interaction

Caution Advised

tramadol + vadadustat

caution advised: combo may incr. risk of seizures (additive effects)

• valacyclovir
Ultracet (tramadol/ acetaminophen)

+

valacyclovir

1 interaction

Caution Advised

tramadol + valacyclovir

caution advised: combo may incr. risk of seizures (additive effects)

• valganciclovir
Ultracet (tramadol/ acetaminophen)

+

valganciclovir

1 interaction

Caution Advised

tramadol + valganciclovir

caution advised: combo may incr. risk of seizures (additive effects)

• varenicline
Ultracet (tramadol/ acetaminophen)

+

varenicline

1 interaction

Caution Advised

tramadol + varenicline

caution advised: combo may incr. risk of seizures (additive effects)