Interactions
Tramal has a variety of interactions with other drugs that can either attenuate its effects or increase its side effects. Therefore, the joint administration of tramal and the following medications should only be given under strict indication. If tramal is taken together with alcohol, or other medications that act on the central nervous system, they can mutually reinforce the effects on the brain and may also cause respiratory arrest or delirium.
Drugs used to treat epilepsy (carbamazepine) can increase the propensity to seize. Together with Tramal this effect is intensified and there is an increased risk of having a seizure. The effect of tramal is not enhanced but rather weakened by other opioids, mainly from the group of mixed antagonists/agonists (e.g. buprenorphine, nalbuphine, pantazocin), which are used to treat severe pain.
Special caution is required when combining blood-thinning agents, especially those from the group of coumarin derivatives (Marcumar, Warfarin). Here the effect of the coumarins is strengthened and it comes to an increased bleeding tendency. In this case the patients should be closely monitored.
With drugs that inhibit Cyp3A4, an enzyme of the liver, as is the case with erythromycin or ketoconazole, for example, the effect of tramal is reduced. The use of tramal should only be used in the following situations after a strict indication. If there is already a dependency on other opiates or an increased propensity to abuse drugs or medication, then one should not take Tramal, because like other opiates it works on the μ receptor and can potentially cause dependency.
Furthermore, one should be very careful with the use of Tramal in case of disturbances of consciousness or shock with unclear cause. One should also be careful with Tramal in the case of increased intracranial pressure, diseases of the brain, in the presence of epilepsy or increased cramping readiness. Tramal should also not be taken if there are disorders of the respiratory center and respiratory function or if there is hypersensitivity to opiates.
In case of liver and kidney dysfunction a strict indication should be given and patients should be monitored. For drops, there is an additional restriction in the case of a congenital fructose intolerance (hereditary fructose intolerance), an uptake disorder for glucose (glucose) and mucus sugar (galactose) or an intolerance for sugar (sucrose). For the retard tablets, there is an additional restriction in the case of an absorption disorder for glucose and mucus sugar, a lactose intolerance and an intolerance to mucus sugar (galactose).
In people over 75 years of age, the dose should be adjusted and the intervals between individual doses extended if necessary. In children under 12 years of age the dosage forms retard tablets, hard capsules and suppositories are not suitable. In infants, the drops and the injection solution are also not recommended.
Regular use should be avoided during pregnancy and lactation. No side effects are to be expected with single doses. During childbirth it does not influence the contractions of the uterus.
After the birth, the newborn baby may experience difficulties in adapting to breathing, but these will quickly disappear on their own.Tramal should not be used at all if there is acute intoxication with alcohol, sleeping pills, painkillers, opioids and psychotropic drugs. Tramal should also not be used under any circumstances if therapy with MAO inhibitors has been carried out in the last 14 days, as this can lead to serotonin syndrome. Furthermore, it is not allowed to use Tramal in cases of drug use and badly adjusted epilepsy.
