General Precautions about Ultram and Using Ultram with Other Drugs
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