Can you take tramadol with acetaminophen, ibuprofen, or aspirin?

Yes, it is safe for most people to take tramadol with acetaminophen, ibuprofen, or aspirin if they are old enough (aspirin is not recommended for children less than 16 years and tramadol should not be taken by children under the age of 12).

Taking tramadol in combination with other medicines can provide better pain relief than just taking one pain-relieving medicine by itself. The combination of tramadol and acetaminophen may be used to relieve acute pain that is severe enough to require an opioid medication, but there are many reasons why you would not want to give an opioid medication. When tramadol and acetaminophen are used together, the combination provides better pain relief than either medicine used alone.

The combination of tramadol and ibuprofen or tramadol and aspirin (in people over the age of 16) also provides better pain relief than either one used alone.

Tramadol should not be taken at the same time as codeine, because both medications are structurally similar, and the combination can result in increased drowsiness. This applies to medications such as Tylenol with codeine or acetaminophen with codeine.

How should you combine tramadol with acetaminophen or ibuprofen?

Always follow the directions given on your medicine’s label. As a general guide for adults (aged 18 to 75 years) in acute pain:

• Tramadol 50 to 100 mg every 4 to 6 hours up to a maximum of 400 mg/day
• Acetaminophen 2 tablets every 4 to 6 hours up to 5 days. Maximum of 8 tablets per day
• Ibuprofen 200 mg to 400 mg up to 4 times a day. Maximum of 4 doses per day.

Caution when taking tramadol with other medications

Tramadol is not suitable for some people, and it should be used with caution in people taking the following medications:

• anticoagulants (blood thinners), such as warfarin, or other drugs that have blood-thinning effects such as aspirin or NSAIDs
• anticonvulsants, such as carbamazepine, phenytoin, phenobarbital, or primidone
• antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
• antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
• any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
• buprenorphine
• diuretics, such as furosemide
• heart medications, such as digoxin
• medications that are metabolized by the same enzymes such as bupropion, erythromycin, fluoxetine, ketoconazole, paroxetine, quinidine, or ritonavir
• migraine medications, such as almotriptan, eletriptan, or sumatriptan
• muscle relaxants, such as cyclobenzaprine
• other medications that affect serotonin, such as amphetamines, fentanyl, lithium, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
• others, such as quinidine, or rifampin.

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Can you take tramadol with supplements or herbal remedies?

Herbal medications that also release serotonin, such as ashwagandha, ginseng, Rhodiola rosea, saffron, and St John’s Wort can interact with tramadol and cause a condition known as serotonin syndrome (symptoms include mental status changes [such as agitation, hallucinations, coma, delirium]), fast heart rate, dizziness, flushing, muscle tremor or rigidity, and stomach symptoms (including nausea, vomiting, and diarrhea).

Using tramadol together with valerian may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Older people may be more at risk.

There may be other herbal/tramadol interactions so always talk to your doctor or pharmacist before taking a herbal supplement.