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6 Interactions found for:

Topamax and tramadol
Interactions Summary
  • 5 Major
  • 1 Moderate
  • 0 Minor
  • Topamax
  • tramadol

Drug Interactions

Moderate
Tramadol + Topamax

The following applies to the ingredients: Tramadol and Topiramate (found in Topamax)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. Sedation and impairment of attention, judgment, thinking, and psychomotor skills may increase.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Hamilton MJ, Bush M, Smith P, Peck AW "The effects of bupropion, a new antidepressant drug, and diazepam, and their interaction in man." Br J Clin Pharmacol 14 (1982): 791-7
  2. Stambaugh JE, Lane C "Analgesic efficacy and pharmacokinetic evaluation of meperidine and hydroxyzine, alone and in combination." Cancer Invest 1 (1983): 111-7
  3. Sotaniemi EA, Anttila M, Rautio A, et al. "Propranolol and sotalol metabolism after a drinking party." Clin Pharmacol Ther 29 (1981): 705-10
  4. Grabowski BS, Cady WJ, Young WW, Emery JF "Effects of acute alcohol administration on propranolol absorption." Int J Clin Pharmacol Ther Toxicol 18 (1980): 317-9
  5. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The effect of fluoxetine on the pharmacokinetics and psychomotor responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
  6. MacLeod SM, Giles HG, Patzalek G, Thiessen JJ, Sellers EM "Diazepam actions and plasma concentrations following ethanol ingestion." Eur J Clin Pharmacol 11 (1977): 345-9
  7. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
  8. Naylor GJ, McHarg A "Profound hypothermia on combined lithium carbonate and diazepam treatment." Br Med J 2 (1977): 22
  9. Stovner J, Endresen R "Intravenous anaesthesia with diazepam." Acta Anaesthesiol Scand 24 (1965): 223-7
  10. Driessen JJ, Vree TB, Booij LH, van der Pol FM, Crul JF "Effect of some benzodiazepines on peripheral neuromuscular function in the rat in-vitro hemidiaphragm preparation." J Pharm Pharmacol 36 (1984): 244-7
  11. Feldman SA, Crawley BE "Interaction of diazepam with the muscle-relaxant drugs." Br Med J 1 (1970): 336-8
  12. Ochs HR, Greenblatt DJ, Verburg-Ochs B "Propranolol interactions with diazepam, lorazepam and alprazolam." Clin Pharmacol Ther 36 (1984): 451-5
  13. Desager JP, Hulhoven R, Harvengt C, Hermann P, Guillet P, Thiercelin JF "Possible interactions between zolpidem, a new sleep inducer and chlorpromazine, a phenothiazine neuroleptic." Psychopharmacology (Berl) 96 (1988): 63-6
  14. Tverskoy M, Fleyshman G, Ezry J, Bradley EL, Jr Kissin I "Midazolam-morphine sedative interaction in patients." Anesth Analg 68 (1989): 282-5
  15. "Product Information. Iopidine (apraclonidine ophthalmic)." Alcon Laboratories Inc PROD
  16. Greiff JMC, Rowbotham D "Pharmacokinetic drug interactions with gastrointestinal motility modifying agents." Clin Pharmacokinet 27 (1994): 447-61
  17. Greb WH, Buscher G, Dierdorf HD, Koster FE, Wolf D, Mellows G "The effect of liver enzyme inhibition by cimetidine and enzyme induction by phenobarbitone on the pharmacokinetics of paroxetine." Acta Psychiatr Scand 80 Suppl (1989): 95-8
  18. Markowitz JS, Wells BG, Carson WH "Interactions between antipsychotic and antihypertensive drugs." Ann Pharmacother 29 (1995): 603-9
  19. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical PROD (2001):
  20. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories PROD (2001):
  21. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) PROD (2001):
  22. "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals PROD (2001):
  23. "Product Information. Meridia (sibutramine)." Knoll Pharmaceutical Company PROD (2001):
  24. "Product Information. Tasmar (tolcapone)." Valeant Pharmaceuticals PROD (2001):
  25. Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11
  26. "Product Information. Precedex (dexmedetomidine)." Abbott Pharmaceutical PROD (2001):
  27. "Product Information. Trileptal (oxcarbazepine)." Novartis Pharmaceuticals PROD (2001):
  28. Ferslew KE, Hagardorn AN, McCormick WF "A fatal interaction of methocarbamol and ethanol in an accidental poisoning." J Forensic Sci 35 (1990): 477-82
  29. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35
  30. "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc (2002):
  31. "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals (2002):
  32. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  33. Cerner Multum, Inc. "Australian Product Information." O 0
  34. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  35. "Product Information. Belsomra (suvorexant)." Merck & Co., Inc (2014):
  36. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):

Drug and Food Interactions

Major
Tramadol + Food

The following applies to the ingredients: Tramadol

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur. In addition, alcohol may affect opioid release from sustained-release formulations.

GENERALLY AVOID: Grapefruit or grapefruit juice may increase the plasma concentrations of opioid analgesics by inhibiting CYP450 3A4-mediated metabolism of these agents, although the interaction has not been studied. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Patients should not consume alcoholic beverages or use drug products that contain alcohol during treatment with opioid analgesics. Any history of alcohol or illicit drug use should be considered when prescribing an opioid analgesic, and therapy initiated at a lower dosage if necessary. Patients should be closely monitored for signs and symptoms of sedation, respiratory depression, and hypotension. Due to a high degree of interpatient variability with respect to grapefruit juice interactions, patients treated with opioid analgesics should preferably avoid the consumption of grapefruit and grapefruit juice.

References

  1. "Product Information. Alfentanil Hydrochloride (alfentanil)." Akorn Inc (2017):
  2. "Product Information. TraMADol Hydrochloride (traMADol)." Advagen Pharma Ltd (2024):
  3. "Product Information. Jamp Tramadol (tramadol)." Jamp Pharma Corporation (2024):
  4. "Product Information. Tramadol (tramadol)." Sigma Pharmaceuticals Plc (2025):
  5. "Product Information. Tramedo (tRAMadol)." Alphapharm Pty Ltd (2024):
  6. "Product Information. Alfentanil (alfentanil)." Hameln Pharma Ltd (2022):
  7. "Product Information. Butorphanol Tartrate (butorphanol)." Apotex Corporation (2024):
  8. "Product Information. Codeine Sulfate (codeine)." Lannett Company Inc (2024):
  9. "Product Information. Meperidine Hydrochloride (meperidine)." Genus Lifesciences Inc. (2024):
  10. "Product Information. Dsuvia (SUFentanil)." AcelRx Pharmaceuticals (2023):
  11. "Product Information. Dzuveo (sufentanil)." Aguettant Ltd (2024):
  12. "Product Information. Pethidine (pethidine)." Martindale Pharmaceuticals Ltd (2025):
  13. "Product Information. Meperidine Hydrochloride (meperidine)." Sandoz Canada Incorporated (2023):
  14. "Product Information. Pethidine (Juno) (pethidine)." Juno Pharmaceuticals Pty Ltd (2024):
  15. Cherrier MM, Shen DD, Shireman L, et al. "Elevated customary alcohol consumption attenuates opioid effects." Pharmacol Biochem Behav 4 (2021): 1-27
  16. Fuhr LM, Marok FZ, Fuhr U, Selzer D, Lehr T "Physiologically based pharmacokinetic modeling of bergamottin and 6,7-dihydroxybergamottin to describe CYP3A4 mediated grapefruit-drug interactions." Clin Pharmacol Ther 114 (2023): 470-82
  17. "Product Information. TraMADol Hydrochloride ER (traMADol)." Trigen Laboratories Inc (2025):
  18. "Product Information. Codeine Contin (codeine)." Purdue Pharma (2025):

Drug and Pregnancy Interactions

The following applies to the ingredients: Tramadol

According to some authorities: Use is not recommended.

AU TGA pregnancy category: C
US FDA pregnancy category: Not Assigned

Risk Summary: Insufficient data are available in humans to inform a drug-related risk; however, prolonged use of opioids during pregnancy for medical or nonmedical purposes can result in respiratory depression and physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth.

Comments:
-Use is not recommended in pregnant women immediately prior to or during labor when other analgesic techniques are more appropriate.
-If prolonged use is required in a pregnant woman, advise the patient of the risk for neonatal opioid withdrawal syndrome, which could be life-threatening if not recognized and treated, and ensure appropriate monitoring and treatment will be available.
-Monitor newborns exposed to this drug for signs of excess sedation, respiratory depression, and neonatal opioid withdrawal syndrome and manage accordingly. An opioid overdose reversal agent must be available for reversal of opioid-induced respiratory depression in the neonate.

Animal studies have revealed decreased fetal weights, reduced ossification, and structural abnormalities in the brains of fetuses. This drug has been shown to cross the placental barrier with an umbilical vein to maternal vein serum concentration ratio of 0.83. There are no controlled data in human pregnancy; however, there have been postmarketing reports of neonatal seizures, neonatal withdrawal syndrome, fetal death, and still birth.

Chronic use of opioids may cause reduced fertility in females and males; however, it is unknown whether these effects are reversible.

AU TGA pregnancy category C: Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. "Product Information. TraMADol Hydrochloride (traMADol)." Advagen Pharma Limited (2026):
  2. "Product Information. TraMADol Hydrochloride ER (traMADol)." Trigen Laboratories Inc (2026):
  3. "Product Information. TraMADol Hydrochloride ER (traMADol)." Lupin Pharmaceuticals Inc (2025):
  4. "Product Information. TraMADol Hydrochloride (traMADol)." TruPharma LLC (2023):
  5. "Product Information. Tramal (tRAMadol)." Seqirus Pty Ltd (2025):
  6. "Product Information. Zamadol SR (tramadol)." Viatris UK Healthcare Ltd (2026):
  7. "Product Information. Brimisol PR (tramadol)." Bristol Laboratories Ltd (2025):
  8. "Product Information. Zydol SR (tramadol)." Grunenthal Ltd (2025):
  9. "Product Information. Zydol XL (tramadol)." Grunenthal Ltd (2025):
  10. "Product Information. Tramadol Hydrochloride (tramadol)." Brown & Burk UK Ltd (2025):
  11. "Product Information. Zydol (tramadol)." Grunenthal Ltd (2025):
  12. "Product Information. Zamadol Melt (tramadol)." Viatris UK Healthcare Ltd (2026):
  13. "Product Information. Tramadol Hydrochloride (tramadol)." Hameln Pharma Ltd (2025):

The following applies to the ingredients: Topiramate (found in Topamax)

This drug should be used during pregnancy only if the benefit outweighs the risk to the fetus.
-According to some authorities: Use is contraindicated unless there are no alternatives for epilepsy.

AU TGA pregnancy category: D
US FDA pregnancy category: Not assigned

Risk Summary: This drug can cause fetal harm when administered to a pregnant woman. Data from pregnancy registries indicate that infants exposed in utero have increased risk of major congenital malformations.

Comments:
-Inform women of childbearing potential of the potential risk to a fetus from exposure to this drug. Alternative treatment options may be advisable. According to some authorities, use is contraindicated in women of childbearing potential (the manufacturer product information should be consulted).
-Advise women of childbearing potential to use effective contraception during treatment. Estrogen-containing birth control may be less effective when used with this drug. According to some authorities, pregnancy testing should be performed prior to starting treatment, and contraception should be used throughout treatment and for at least 4 weeks after stopping this drug.
-A pregnancy exposure registry is available.
-Monitor pregnant patients and newborns of mothers exposed to this drug for metabolic acidosis and treat as appropriate. The effect of metabolic acidosis induced by this drug has not been studied in pregnancy; however, metabolic acidosis due to other causes in pregnancy can elicit decreased fetal oxygenation and growth as well as fetal death.
-According to some authorities, antiepileptic therapy should be continued during pregnancy using monotherapy at the lowest effective dose whenever possible. Folic acid supplementation (5 mg) should be commenced four weeks prior to and continued for twelve weeks after conception. Women should be followed by a specialist and offered detailed mid-trimester ultrasound.

Animal studies have revealed evidence of embryotoxicity and teratogenicity. There are no controlled data in human pregnancy; however, data from pregnancy registries have shown that infants exposed in utero have increased risk of cleft lip and/or cleft palate (oral clefts) and of being small for gestational age (SGA). SGA has been observed at all doses and appears to be dose-dependent.

To monitor the outcomes of pregnant women exposed to this drug, The North American Antiepileptic Drug in Pregnancy Registry has been established. Physicians are encouraged to register patients and pregnant women are encouraged to register themselves by visiting https://www.aedpregnancyregistry.org/join-our-study/.

Based on limited data, this drug has been associated with pre-term labor and premature delivery. In addition, metabolic acidosis induced by this drug may affect the ability of the fetus to tolerate labor.

AU TGA pregnancy category D: Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D and X are being phased out.

References

  1. "Product Information. Topiramate (topiramate)." Advagen Pharma Limited (2025):
  2. "Product Information. toPAMAX (topiramate)." Janssen-Cilag Pty Ltd (2026):
  3. "Product Information. Topiramate (topiramate)." Viatris UK Healthcare Ltd (2025):

Drug and Breastfeeding Interactions

The following applies to the ingredients: Tramadol

Use is not recommended

Excreted into human milk: Yes

Comments:
-The US FDA recommends against the use of tramadol during breastfeeding due to risks of serious adverse reactions in breastfed infants; this drug 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.
-If infants are exposed through breastmilk, they should be monitored for excess sedation and respiratory depression.

Serious adverse reactions in breastfed infants may include excess sleepiness, difficulty breastfeeding, or serious breathing problems that could result in death. Newborns have limited capacity to metabolize the active 0-desmethyltramadol.

A study in 75 mothers reported an average milk concentration of 748 mcg/L; this translates to an average infant dose of 112 mcg/kg and a maternal weight-adjusted dose of 2.24% and 0.64% for the drug and its metabolite, respectively. Reanalysis of the data using a population pharmacokinetic model showed a maternal weight adjusted dose of 2.2% for extensive metabolizers and 2.6% for poor metabolizers. The amount of drug present in breast milk represents a maximum of 2.6% of the proposed IV newborn dose. This drug can increase prolactin levels; however, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
  5. "Product Information. Ultram ER (tramadol)." PriCara Pharmaceuticals (2015):
  6. US Food and Drug Administration (FDA) "FDA Drug Safety Communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. https://www.fda.gov/Drugs/DrugSafety/ucm549679.htm" (2017):

The following applies to the ingredients: Topiramate (found in Topamax)

Benefit should outweigh risk

Excreted into human milk: Yes

Comments:
-The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for this drug and any potential adverse effects on the breastfed infant from this drug or from the underlying maternal condition.
-If this drug is used during breastfeeding, monitor breastfed infant for diarrhea, drowsiness, adequate weight gain, and developmental milestones, especially younger, exclusively breastfed infants.
-Some authorities recommend avoiding breastfeeding during therapy with this drug.

Limited data in women with epilepsy have shown drug levels in milk similar to those in maternal plasma. The excretion of topiramate has not been evaluated in controlled studies.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
  4. "Product Information. Qudexy XR Sprinkle (topiramate)." Upsher-Smith Laboratories Inc (2017):
  5. "Product Information. Trokendi XR (topiramate)." Supernus Pharmaceuticals Inc (2017):
  6. "Product Information. Topiramate (topiramate)." Cipla USA Inc. (2017):

Therapeutic Duplication Warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

Switch to: Consumer Interactions

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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