Alprazolam with Tramadol Interaction Details
Brand Names Associated with Alprazolam
- Alprazolam
- Niravam®
- Xanax®
- Xanax® XR
Brand Names Associated with Tramadol
- Conzip®
- Qdolo®
- Rybix® ODT
- Ryzolt®
- Seglentis® (as a combination product containing Celecoxib, Tramadol)
- Tramadol
- Ultracet® (as a combination product containing Acetaminophen, Tramadol)
- Ultram®
- Ultram® ER
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Feb 27, 2024
Interaction Effect
Increased risk of respiratory and CNS depression
Interaction Summary
Reserve the concomitant use of traMADol and CNS depressants to patients for whom alternatives are inadequate. If concomitant use is necessary, use the lowest dose and shortest duration necessary to achieve treatment goals. Consider using a lower dose of traMADol or the CNS depressant and closely monitor for sedation and respiratory depression[1][2].
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Reserve the concomitant use of traMADol and CNS depressants to patients for whom alternatives are inadequate. If concomitant use is necessary, use the lowest dose and shortest duration necessary to achieve treatment goals. Consider using a lower dose of traMADol or the CNS depressant and closely monitor for sedation and respiratory depression[1][2].
Mechanism Of Interaction
Additive CNS depression
Literature Reports
A) Between 2004 and 2011, there was an increase in nonmedical use-related emergency department visits involving opioid analgesics and benzodiazepines (from 11 to 34.2 per 100,000 population). During this timeframe, drug over dose deaths from taking the prescribed or greater than prescribed doses of both opioid analgesics and benzodiazepines also increased (from 0.6 to 1.7 per 100,000). The proportion of prescription opioid analgesic overdose deaths that were associated with benzodiazepine use also increased from 18% to 31% [3].
B) The rate of overdose death among patients co-dispensed benzodiazepines and opioid analgesics were 10 times higher than patients dispensed opioid analgesics alone (7 per 10,000 person years vs 0.7 per 10,000 person years). Patients taking opioid analgesics who had a history of benzodiazepine prescriptions had an increased risk of fatal overdose compared with patients taking opioid analgesics with no history of benzodiazepine prescription. A similar risk of fatal overdose was observed in patients with a current benzodiazepine prescription. The risk of drug overdose death increased as the daily benzodiazepine dose also increased [3].
References
1 ) Product Information: ULTRAM(R) oral tablets, tramadol HCl oral tablets. Janssen Pharmaceuticals, Inc. (per FDA), Titusville, NJ, 2016.
2 ) Product Information: CONZIP(R) oral extended-release capsules, tramadol HCl oral extended-release capsules. Vertical Pharmaceuticals, LLC (per FDA), Sayreville, NJ, 2016.
3 ) US Food and Drug Administration (FDA): Drug Safety Communications: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. US Food and Drug Administration (FDA). Silver Spring, MD. 2016. Available from URL: http://www.fda.go... . As accessed 2016-08-31.
Alprazolam Overview
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Alprazolam is used to treat anxiety disorders and panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks). Alprazolam is in a class of medications called benzodiazepines. It works by decreasing abnormal excitement in the brain.
Tramadol Overview
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Tramadol is used to relieve moderate to moderately severe pain in adults and children 12 years of age or older. Tramadol extended-release tablets and capsules are only used by people who are expected to need medication to relieve pain around-the-clock. Tramadol is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.