General Precautions about Ultram and Using Ultram with Other Drugs

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Some drugs may detrimentally affect the way the body responds to Ultram. For example, pain

medications, such as pentazocine, butorphanol, naltrexone and nalbuphine can interrupt the

body's ability to take up Ultram. Another class of drugs that can adversely affect the benefits of

Ultram are the monoamine oxidase inhibitor (MAOI) drugs, in the range of selegiline, which is

known as Eldepril or Emsam; rasagiline; tranylcypromine, also known as Parnate; phenelzine,

also called Nardil; pocarbazine; methylene blue; moclobemide; isocarboxizid, also called

Marplan; and linezolid. None of these drugs should be administered along with Ultram, or for

two weeks after the drugs on this list have been used. Death can occur when these drugs are

mixed with Ultram.

When visiting the doctor, patients should announce before receiving a prescription if they take

any of the following antidepressants: nortriptyline, also known as Pamelor; paroxetine, sold

as Paxil; sertraline, prescribed as Zoloft; fluvoxamine, better known as Luvox; imipramine,

also referred to as Tofranil; escitalopram, available as Lexapro; fluoxetine, which is prescribed

as Sarafem and Prozac; citalopram, also known as Celexa; despiramine, available as

Norpramin; and amitriptyline, prescribed as Elavil or Vanatrip. When taken with Ultram, these

antidepressants can contribute to seizures.


Medical professionals should know in advance whether or not patients are already using a

drug that influences or increases serotonin in the body. These drugs include St. John's wort;

lithium, prescribed as Eskalith and Lithobid; sibutramine; plus dextromethorphan. Also, the

doctor should be informed if a patient uses the illegal drug known as “ecstasy” before Ultram is



Medicines prescribed for Attention Deficit Hyperactivity Disorder (ADHD) should be brought to

the physician's attention. These include Ritalin, Adderal and Strattera.

If a patient uses selective serotonin reuptake inhibitor (SSRI) drugs, such as citalopram or

paraoxetine, this should be mentioned before accepting an Ultram prescription. Another drug

family that needs to be mentioned to the physician before prescribing Ultram is serotonin and

norepinephrine reuptake inhibitor (SNRI) drugs, most notably duloxetine or venlafaxine. Also,

any triptan drugs prescribed for migraine headache treatment, like eletriptan or sumatriptan,

which is sold under the brand names of Treximet and Imitrex, should be explained to a doctor

before prescribing Ultram. The inhibitors CYP2D6 and CYP3A4 can also cause problems and

should be mentioned in advance of accepting an Ultram prescription. Mixing these drugs with

Ultram can result in serotonin syndrome, a potentially fatal situation.


On the other side of the list are medications which can remove Ultram from your system,

stopping any effectiveness the drug may have. An antifungal agent, like itraconazole, is a good

example. Also, an antibiotic cream, such as erythromycin, or antibiotics extracted from the

bacterium amycolatopsis mediterranei, also known as rifamycins, prescribed as rifampin are both

known to block the body's ability to use Ultram. An antifungal agent, such as itraconazole, has

a negative effect on Ultram's absorption in your body. A list of antibiotics that stops Ultram's

effectiveness includes rifampin, prescribed as Rimactane, Rifadin and Rifater; telithromycin,

sold as Ketek; erythromycin, available as Ery-Tab, Pediazole, EyPed, E.E.S. and Erythrocin;

linezolid, prescribed with the brand name Zyvox; and clarithromycin, which is also known as

Zyvox. Antifungal medicines, such as miconazole, referred to as Oravig; voriconazole, known

as Vfend; intraconazole, also called Sporanox; clotrimazole, available as Mycelex Troche; and

ketoconazole, sold under the brand name Nizoral.


Patients who take seizure drugs, such as Carbatrol or carbamazepine, which is available under

the names Carbatrol, Tegretol, or Equetro, should be aware that these drugs eliminate Ultram's

ability to work. Some cancer drugs, such as imatinib, also sold as Gleevec; gefitinib, prescribed

as Iressa: and nilotinib, sold as Tasigna also inhibit Ultram in your body.


Patients need to mention the following blood pressure or heart medications to their medical

professional: diltiazem, a drug sold under the brand names Cardizem and Cartia; verapamil, also

referred to as Covera, Isoptin, Verelan or Calan; propafenone, prescribed as Rythmol; nifedipine,

known also as Nifedical and Procardia; quinidine, also known as Quin-G; felodipine, which has

the brand name Plendil; amiodarone, available as Mycelex or Troche; and flecainide, available

under the name Tambocor.


The following HIV/AIDS medications should be brought to your physician's attention:

saquinavir, which is available under the brand name Invirase; ritonavir, prescribed with the

names Kaletra and Norvir; indinavir, also referred to as Crixivan; nelfinavir, sold as Viracept;

atazanavir, prescribed under the name Reyataz; fosamprenavir, with the brand name Laxiva; and

delavirdine, also known as Rescriptor.


Because one of the side effects of Ultram is drowsiness, doctors should be told if patients are

already using any products that can also cause sleepiness. The list of these drugs may include

medications taken to cause sleep, such as diazepam, alprazolam or zolpidem; allergy and cold

medications; narcotic drugs already taken for pain, such as morphine; drugs that relax muscles;

and drugs which are prescribed for psychiatric conditions, like amitriptyline, risperidone and