https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=15607
https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=15607
No pharmaceutical opinion available for this interaction.
Atazanavir / cobicistat can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Tramadol.
Atazanavir / cobicistat may inhibit the metabolism (CYP2D6) and decrease the active metabolite formation of Tramadol.
–
–
–
Possible decrease of clinical efficacy.
Possible increase of adverse effects.
Use this combination with caution.
Monitor the clinical efficacy and appearance of adverse effects.
Adjust dosage if necessary.
See comments for further details.
Hydromorphone and morphine.
Signs and symptoms of opioid withdrawal : craving for opioids, irritability, myalgias, muscle spasms, flushing, abdominal pain, nausea, vomiting, diarrhea, restlessness, diaphoresis, lacrimation, rhinorrhea, mydriasis, yawning, piloerection (goose flesh), tachycardia, tremulousness.
Adverse effects of tramadol : dizziness, nausea, constipation, headache, seizures, suicidal tendencies, and serotonin syndrome including changes in mental status (agitation, hallucinations, coma), autonomic instability (tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (hyperreflexia, incoordination) and gastrointestinal symptoms (nausea, vomiting, diarrhea).
–
–
M1 six times more powerful than parent molecule and M2 (about 1/5 strength of M1) and go through 2D6 transformed in M5 weakly active (less than M1).
Possible reduction of the analgesic effect due to the decrease in the formation of the active metabolite M1. We observe in rapid metabolizers 2D6 M1/tramadol ratio 14 times higher compared to the 2D6 metabolizers slow.
The interaction could be more important in slow metabolisers of 2D6. We observe in rapid metabolizers 2D6 M1/tramadol ratio 14 times higher compared to the 2D6 metabolizers slow.