Warfarin with Tramadol Interaction Details
Brand Names Associated with Warfarin
- Coumadin®
- Jantoven®
- Warfarin
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 increase in prothrombin time and an increased risk of bleeding
Interaction Summary
Elevated prothrombin times and alteration of warfarin effect have occurred during coadministration of warfarin and traMADol.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Closely monitor INR and adjust warfarin doses accordingly; monitor for signs and symptoms of bleeding and bruising.
Mechanism Of Interaction
Unknown
Literature Reports
A) In a case report, the concurrent administration of traMADol and warfarin resulted in prolongation of the INR to 7.31 in a 76-year-old male patient. He presented to the hospital with dried blood blisters on each great toe which had been present for approximately 10 days. He had a history of hypertension, benign prostatic hypertrophy, left bundle-branch block, degenerative joint disease, and an aortic valve replacement. In addition to traMADol 50 mg three times daily and warfarin 5 mg daily, he was taking captopril 25 mg three times daily and hydrochlorothiazide/triamterene daily. The INR decreased after warfarin and traMADol were discontinued. Since traMADol and warfarin are metabolized by different isoenzymes of cytochrome P450, the mechanism of this interaction is unknown .
B) Extensive bruising of the right upper arm occurred in a 61-year-old female approximately two weeks following the addition of traMADol 50 mg every six hours to her therapeutic regimen. Other medications included warfarin 45 mg weekly, digoxin 0.25 mg daily, phenytoin 300 mg daily, levothyroxine 0.1 mg daily, and folic acid 1 mg daily. No changes in her warfarin dose had been made in the previous three months, and her other medications had been at a stable dose for two years. At the time of presentation, the patient's traMADol therapy was completed, and her prothrombin time was 39.6 seconds while INR was 10.6. Warfarin therapy was withheld until the INR fell to within the therapeutic range, and the patient eventually resumed her previous warfarin dose without further complications .
Warfarin Overview
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Warfarin is used to prevent blood clots from forming or growing larger in your blood and blood vessels. It is prescribed for people with certain types of irregular heartbeat, people with prosthetic (replacement or mechanical) heart valves, and people who have suffered a heart attack. Warfarin is also used to treat or prevent venous thrombosis (swelling and blood clot in a vein) and pulmonary embolism (a blood clot in the lung). Warfarin is in a class of medications called anticoagulants ('blood thinners'). It works by decreasing the clotting ability of the blood.
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.