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There are reports of acute overdosage with tramadol. Signs and symptoms can manifest by respiratory depression, sleepiness progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, seizures, slow heart rate, low blood pressure (hypotension), cardiac arrest, and death. Deaths due to overdose have been reported with abuse and misuse of tramadol.

Tramadol may interact with quinidine, fluoxetine, paroxetine, amitriptyline, ketoconazole, erythromycin, SSRIs, MAOIs, triptans, linezolid, lithium, St. John's wort, carbamazepine, rifampin, and digoxin. There are no adequate and well-controlled studies of tramadol in pregnant women. Tramadol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Neonatal seizures, neonatal withdrawal syndrome, fetal death and stillbirth have been reported during post-marketing. Tramadol is not recommended for obstetrical preoperative medication or for post-delivery analgesia in nursing mothers because its safety in infants and newborns has not been studied.

Other drugs in the same class as tramadol include codeine hydrocodone (Zohydro ER), oxycodone (OxyContin, Roxicodone), methadone hydromorphone (Dilaudid, Exalgo), morphine (Avinza, Kadian, MSIR, MS Contin), fentanyl (Actiq, Duragesic). If you have questions about this drug talk to your doctor, pharmacist, or other medical professional.

REFERENCE: FDA Prescribing Information for tramadol.

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