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3. Duplicative Therapy

Adjunctive administration of multiple tramadol dosage forms may result in significant additive adverse events, including respiratory depression, seizures, and serotonin syndrome. Tramadol/acetaminophen combination products should not be used with other tramadol or acetaminophen containing products. Tramadol/celecoxib combination products should not be used with other tramadol or celecoxib containing products2-11. 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 reduced2-11.

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 combination2-11.