Substance
What not to mix with Tramadol
Opioid
Also calledtram, ultram
Opioid plus serotonin reuptake inhibition, and seizure risk
Summary
Tramadol is checked against 40 other substances — 22 dangerous, 11 unsafe and 3 caution.
Dangerous
22- Tramadol and AlcoholHeavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of…
- Tramadol and AmphetaminesTramadol and stimulants both increase the risk of seizures.
- Tramadol and AMTHigh risk of death or life-changing injury. Do not combine.
- Tramadol and BenzodiazepinesCentral nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration is a risk when passed…
- Tramadol and BuprenorphineConcomitant use of tramadol increases the seizure risk in individuals taking other opioids. These agents are often individually epileptogenic and may…
- Tramadol and CocaineTramadol and stimulants both increase the risk of seizures.
- Tramadol and CodeineStacking codeine onto a stronger opioid adds meaningful respiratory depression for very little extra effect — the worst possible ratio. Codeine is…
- Tramadol and DiphenhydramineBoth drugs increase the risk of serotonin syndrome. While at medical dosages, this is unlikely to be of concern, recreational doses should be…
- Tramadol and DXMHigh risk of death or life-changing injury. Do not combine.
- Tramadol and FentanylTolerance built on heroin or oxycodone does not translate cleanly to fentanyl, and fentanyl is increasingly what is actually in both. Stacking them…
- Tramadol and GHB / GBLThe sedative effects of this combination can lead to dangerous respiratory depression.
- Tramadol and KetamineHigh risk of death or life-changing injury. Do not combine.
- Tramadol and LithiumTramadol and Lithium both increase the risk of seizures and serotonin syndrome.
- Tramadol and MAOIsHigh risk of death or life-changing injury. Do not combine.
- Tramadol and MDMATramadol and stimulants both increase the risk of seizures.
- Tramadol and MephedroneThere is a high risk of serotonin syndrome and seizures at recreational dosages. Both substances affect the heart and may lead to further dangerous…
- Tramadol and MethadoneUsing heroin or oxycodone on top of methadone is dosing into an opioid load that is still there whether or not you feel it. Because methadone blunts…
- Tramadol and MethamphetamineTramadol and stimulants both increase the risk of seizures.
- Tramadol and MXEHigh risk of death or life-changing injury. Do not combine.
- Tramadol and OpioidsConcomitant use of tramadol increases the seizure risk in individuals taking other opioids. These agents are often individually epileptogenic and may…
- Tramadol and PCPHigh risk of death or life-changing injury. Do not combine.
- Tramadol and SSRIsHigh risk of death or life-changing injury. Do not combine.
Unsafe
11- Tramadol and 2C-T-xRisk of serious physical or psychological harm. Not recommended under any circumstances.
- Tramadol and 2C-xTramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.
- Tramadol and 5-MeO-xxTRisk of serious physical or psychological harm. Not recommended under any circumstances.
- Tramadol and DMTTramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.
- Tramadol and DOxTramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.
- Tramadol and KratomTramadol lowers the seizure threshold and inhibits serotonin reuptake on top of its opioid action; kratom adds opioid effect and mild serotonergic…
- Tramadol and LSDTramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.
- Tramadol and MescalineThis combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.
- Tramadol and MushroomsTramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.
- Tramadol and NBOMesTramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures
- Tramadol and PregabalinThere is a significant risk of seizures. Both substances are CNS depressants, potentiating each other strongly and unpredictably, raising the chances…
Caution
3- Tramadol and AcetaminophenTramadol is sold in acetaminophen combination products in many countries. Check the label before adding Tylenol so you do not exceed the daily…
- Tramadol and MelatoninAdditive sedation, plus tramadol's own serotonergic activity. Reported serotonin-syndrome cases involving melatonin are very rare, but tramadol is…
- Tramadol and Nitrous OxideBoth substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While…
Low / synergy
1Low / no synergy
3Checking more than one?
This page rates Tramadol against one substance at a time. Combinations of three or more carry risks that no pair-by-pair list can show — the checker rates every pair at once and flags the whole-mix ones on top.
Open Tramadol in the checkerOther opioids
All combinations →Educational information only, not medical advice. Absence of a documented interaction is not evidence of safety. Combination data from the TripSit drug combination chart, retrieved 2026-08-20.