Drug General Information (ID: DDII9PY5TC)
Drug Name			Tramadol		Drug Info		Morphine (liposomal)		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Analgesics				Analgesics
Structure

Mechanism of Tramadol-Morphine (liposomal) Interaction (Severity Level: Major)
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Tramadol				Morphine (liposomal)
Mechanism 1		CNS depression effects				CNS depression effects
Key Mechanism Factor 1
		Factor Name		CNS depression effects
		Factor Description		CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin.
Mechanism Description		Additive CNS depression effects by the combination of Tramadol and Morphine (liposomal)
Additive hypotensive effects Click to Show/Hide Mechanism Graph
Drug Name		Tramadol				Morphine (liposomal)
Mechanism 2		Antihypertensive agent				Antihypertensive agent
Key Mechanism Factor 2
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Tramadol and Morphine (liposomal)
Mechanism 3		Hypotensive effects				Antihypertensive agent
Key Mechanism Factor 3
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Tramadol and Morphine (liposomal)
Mechanism 4		Antihypertensive agent				Hypotensive effects
Key Mechanism Factor 4
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Tramadol and Morphine (liposomal)
Mechanism 5		Hypotensive effects				Hypotensive effects
Key Mechanism Factor 5
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Tramadol and Morphine (liposomal)
Increased risk of lowers seizure threshold Click to Show/Hide Mechanism Graph
Drug Name		Tramadol				Morphine (liposomal)
Mechanism 6		Lower seizure threshold				Lower seizure threshold
Key Mechanism Factor 6
		Factor Name		Lowers seizure threshold
		Factor Description		The combination of medications that lower the seizure threshold is a factor that makes people with epilepsy more likely to have seizures. A seizure is a sudden, uncontrolled electrical disturbance in the brain that can cause changes in your behavior, movements or sensations, and level of consciousness.
Mechanism Description		Increased risk of lowers seizure threshold by the combination of Tramadol and Morphine (liposomal)

Recommended Action
Management		Concomitant use of tramadol with other opioids should generally be avoided. If coadministration is necessary, the dosage and duration of each drug should be limited to the minimum required to achieve desired clinical effect. Patients should be monitored closely for development of seizures, respiratory depression and sedation, and advised to avoid driving or operating hazardous machinery until they know how these medications affect them. Cough medications containing opioids (e.g., codeine, hydrocodone) should not be prescribed to patients on tramadol. In addition, tramadol should not be used in opioid-dependent patients, and use in patients who are chronically on opioids is also not recommended. Tramadol is contraindicated in patients with acute opioid intoxication.

References
1	Product Information. Fycompa (perampanel). Eisai Inc, Teaneck, NJ.
2	Product Information. Ultram (tramadol). McNeil Pharmaceutical, Raritan, NJ.
3	Product Information. Zohydro ER (HYDROcodone). Zogenix, Inc, San Diego, CA.