MECHANISM OF ACTION
Tramadol and tricyclic compounds, including
carbamazepine, may lower the seizure threshold.(1) Carbamazepine may also
induce the metabolism of tramadol.(1)
DISCUSSION
The use of tramadol in patients treated with tricyclic
compounds may increase the risk of seizures.(1) A review of 124 reports of
seizures following tramadol therapy received by the FDA through July 31,
1996 revealed that 23% of the patients were also taking tricyclic
antidepressants.(3) Therefore, the manufacturer of tramadol states that
tramadol should be used with caution in patients treated with tricyclic
compounds.(1) The manufacturer of tramadol also states that the use of
tramadol with carbamazepine is not recommended.(1)
CLINICAL EFFECTS
Concurrent use of tramadol and a tricyclic compound may
result in seizures(1) or serotonin syndrome.(2) Concurrent use of tramadol
and carbamazepine may result in seizures and decreased efficacy of tramadol.
(1)
SEVERITY LEVEL
2-Severe Interaction: Action is required to reduce the risk
of severe adverse interaction.
PATIENT MANAGEMENT
Tramadol should be used with caution in patients taking
tricyclic compounds.(1) The use of tramadol and carbamazepine is not
recommended.(1)
PREDISPOSING FACTORS
Risk of seizures may be increased in patients with
epilepsy, a history of seizures, head trauma, metabolic disorders, alcohol
or drug withdrawal, or infections of the central nervous system.(1)
REFERENCES