Tramadol Alcohol

Tramadol Acute intoxication with alcohol, hypnotics, narcotics, centrally acting analgesics, opioids, or psychotropic drugs. 

Avoid alcohol and OTC drugs such as analgesics and sedatives during tramadol... 

The success of prolonged-release morphine prompted the development of prolonged-release formulations for other opioids, for example the matrix made of hydrophobic and hydrophilic matrix formers, for example on hydrocodeine (DHC retard with cetostearyl alcohol and hydroxyethyl-cellulose), oxycodone (oxygesic with stearyl alcohol and polyacrylate) and tramadol (tramundin with cetostearyl alcohol and ethylcellulose). By virtue of the oblong shape of hydrocodeine and tramadol tablets the prolonged-release tablets can be divided, whereby compared with whole tablets release from the divided tablets is slightly accelerated. The difference with these forms is that with increasing dose the release slows down. 

Woody, G.E. et al., An independent assessment of MEDWatch reporting for abuse/ depen den ce and withdrawal from Ultram (tramadol hydrochloride), Drug Alcohol Depend., 72, 163, 2003. 

The death of a 36-year-old patient with a history of alcohol dependence who was taking tramadol, venlafaxine, trazodone, and quetiapine has highlighted the increased risk of seizures with concomitant use of tramadol and selective serotonin re-uptake inhibitors (125). 

A 30-year-old woman, with a history of depression, was found dead after taking an unknown quantity of alprazolam, tramadol, and alcohol. At autopsy, only slight decomposition and diffuse visceral congestion were observed. Blood concentrations of alprazolam, alcohol, and tramadol were 0.21 mg/1, 1.29 g/kg, and 38 mg/1 respectively. 

Tramadol, phenothiazine antipsychotics and the majority of antidepressants, as well as a number of other drugs, can lower the seiznre threshold and are associated with an increased risk of convnlsions [6]. Again, these drugs may accumulate in patients with liver impairment such as cirrhosis or acute liver failure, and care must be taken if choosing to use them. This is especially important in alcoholics, who have an increased risk of seizures from acute alcohol withdrawal [7]. Examples of drugs that can lower the seizure threshold and should be used with caution/avoided are ... 

In patients with alcoholic liver disease who are prone to alcoholic seizures, it is best to avoid pethidine and tramadol because of their epileptogenic potential. 

Tramadol lowers the seizure threshold and could also precipitate seizures in susceptible individuals [48], such as alcoholics. 

Tramadol can lower the seizure threshold, which could precipitate seizures in susceptible individuals, e.g. alcoholics. 

P450 enzyme inhibition by SSRIs may also augment effects of alcohol, tramadol, methadone, terfenadine (danger of cardiac arrhythmia), -caine anaesthetics and theophylline. 

Cicero TJ, Adams EH, GeUer A, Inciardi JA, Munoz A, Schnoll SH, Senay EC, Woody GE. A postmarketing surveillance program to monitor Ultram (tramadol hydrochloride) abuse in the United States. Drug Alcohol Depend 1999 57(l) 7-22. 

Clinically important, potentially hazardous interactions with alcohol, antidepressants, aspirin, heparin, linezolid, lithium, NSAIDs, sibutramine, tramadol, warfarin... 

Tramadol 50-100 mg every 4-6 hours not to exceed 400 mg/day has narcotic-like effect contraindicated in alcohol or hypnotic intoxication drug interactions expensive... 

Two cases of the serotonin syndrome have been reported when tramadol was given with venlafaxine one patient was also receiving mirtazapine. Fatal seizures occurred in an alcoholic man receiving tramadol, venlafaxine, quetiapine and trazodone. 

Tramadol ER should not be administered to patients who have previously demonstrated hypersensitivity to tramadol, any other component of this product or opioids. Tramadol ER is contraindicated in any situation where opioids are contraindicated, including acute intoxication with any of the following alcohol, hypnotics, narcotics, centrally acting analgesics, opioids, or psychotropic drugs. Tramadol ER should not be used in patients with creatinine clearance less than 30 mL/min, or severe hepatic impairment (diild-Pugh Class C). 

Tramadol ER must be swallowed whole and must not be chewed, crushed, or split. Chewing, crushing, or splitting the tablet will result in the uncontrolled delivery of the opioid and could result in overdose and death. This risk is increased with concurrent abuse of alcohol and other substances. Tramadol, like other opioids used in analgesia, can be abused [1,2]. 

Seizures have been reported in patients receiving tramadol. The risk of seizure is increased with doses of tramadol above the recommended range. Concomitant use of tramadol increases the seizure risk in patients taking tricyclic antidepressants, selective serotonin reuptake inhibitors, or other opioids. Tramadol may enhance the seizure risk in patients taking MAO inhibitors, neuroleptics, or other drugs that reduce the seizure threshold. Risk of convulsions may also increase in patients with epilepsy, those with a history of seizures, or in patients with a recognized risk for seizure (such as head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infections). 

Tramadol ER should be used with caution and in reduced dosages when administered to patients receiving CNS depressants such as alcohol, opioids, anesthetic agents, narcotics, phenothiazines, tranquilizers, antidepressants, or sedative hypnotics. Tramadol ER increases the risk of CNS and respiratory depression in these patients. 

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