3. Duplicative Therapy

Adjunctive administration of multiple tramadol dosage forms may result in significant additive adverse events, including respiratory depression, seizures, and serotonin syndrome. Combined administration of multiple tramadol dosage forms is not recommended and will be reviewed.

Opioid analgesics may enhance the sedative effects as well as other central effects of tramadol. Therefore, the use of tramadol in conjunction with opioid analgesics is recommended cautiously. If tramadol is used concomitantly with another agent that acts upon the central nervous system, the tramadol dosage should be reduced.

Use of tramadol in conjunction with sedative/hypnotics in patients over 75 years of age will be reviewed as these patients may be more sensitive to the additive effects of this drug combination^2-6.