Tramadol with Phenprocoumon Interaction Details
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
Nov 11, 2023
Interaction Effect
An increased risk of bleeding
Interaction Summary
Concurrent use of traMADol and phenprocoumon may increase the anticoagulant activity of phenprocoumon. However, other researchers have found no effect on anticoagulant activity of phenprocoumon in patients also receiving traMADol . If concomitant therapy is necessary, monitor INR and adjust the phenprocoumon dose accordingly.
Severity
Moderate
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
If concomitant therapy is necessary, monitor INR and adjust the phenprocoumon dose accordingly.
Mechanism Of Interaction
Inhibition by traMADol or one of its metabolites of phenprocoumon metabolism
Literature Reports
A) A 66-year-old woman with idiopathic lung fibrosis was given traMADol (100 mg four times daily) for pain caused by a fractured lumbar vertebra. She also was taking estazolam 250 mg four times daily, diflunisal 50 mg three times daily, oxazepam 30 mg once daily, calcium (400 mg) and vitamin D (5 mcg) twice daily, and acetaminophen 1 g four times daily. One month later, she was started on heparin (12,500 IU twice daily) and phenprocoumon for a pulmonary embolism. Phytomenadione 2 mg was administered after a rise in INR was noted. TraMADol was discontinued on day 8 and three days later, the INR was stable at about 2. It is suggested that the prolonged rise in INR could be a pharmacodynamic interaction in which traMADol potentiated the action of phenprocoumon on vitamin K epoxide reductase. TraMADol and phenprocoumon are metabolized by CYP2D6 and CYP2C9 isoenzymes, respectively. However, it is still suggested that the most likely mechanism for this interaction is inhibition of phenprocoumon metabolism in the liver by traMADol or one of its metabolites .
B) TraMADol 50 mg three times daily given for one week had no effect on the level of anticoagulant activity of phenprocoumon in 19 patients stabilized to an INR between 3 to 4.5 in a double-blind, placebo controlled, randomized trial. The average daily phenprocoumon dose was the same for individuals receiving traMADol and placebo .
Tramadol Overview
-
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.