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 AlcoholBoth are heavy depressants: together they can cause seizures and sudden unconsciousness. Do not combine. If someone passes out, put them on their…
- Tramadol and AmphetaminesBoth raise the risk of a seizure, and together that risk adds up. Do not combine.
- Tramadol and AMTHigh risk of death or life-changing injury. Do not combine.
- Tramadol and BenzodiazepinesTogether they can slow breathing and knock you out. Do not combine. If someone passes out, put them on their side so they cannot choke on vomit.
- Tramadol and BuprenorphineTramadol raises the seizure risk, and together they can slow breathing. Do not combine. Keep naloxone nearby.
- Tramadol and CocaineBoth raise the risk of a seizure, and together that risk adds up. Do not combine.
- Tramadol and CodeineCodeine adds a lot of slowed breathing for very little extra effect. Do not combine. Keep naloxone nearby.
- Tramadol and DiphenhydramineBoth add to the risk of serotonin syndrome, and diphenhydramine may raise tramadol's seizure risk. Do not combine at recreational doses.
- Tramadol and DXMHigh risk of death or life-changing injury. Do not combine.
- Tramadol and FentanylYour tolerance to heroin or pills does not carry over cleanly to fentanyl, which is increasingly what is in both anyway. Do not combine. Never use…
- Tramadol and GHB / GBLTogether they can slow breathing dangerously. Do not combine.
- Tramadol and KetamineHigh risk of death or life-changing injury. Do not combine.
- Tramadol and LithiumBoth raise the risk of seizures and of serotonin syndrome. Do not combine.
- Tramadol and MAOIsHigh risk of death or life-changing injury. Do not combine.
- Tramadol and MDMABoth raise the risk of a seizure, and together that risk adds up. Do not combine.
- Tramadol and MephedroneAt recreational doses this risks serotonin syndrome, seizures and heart trouble, and if one wears off first the other can overwhelm you. Do not…
- Tramadol and MethadoneMethadone is still there whether you feel it or not, and it blunts other opioids, so people take more of them. Do not combine. Keep naloxone nearby.
- Tramadol and MethamphetamineBoth raise the risk of a seizure, and together that risk adds up. Do not combine.
- Tramadol and MXEHigh risk of death or life-changing injury. Do not combine.
- Tramadol and OpioidsTramadol raises the seizure risk, and together they can slow breathing. Do not combine. Keep naloxone nearby.
- 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 lowers the seizure threshold and psychedelics raise seizure risk, so together a seizure becomes more likely. Avoid this combination.
- Tramadol and 5-MeO-xxTRisk of serious physical or psychological harm. Not recommended under any circumstances.
- Tramadol and DMTTramadol lowers the seizure threshold and psychedelics can cause seizures, so together a seizure becomes more likely. Avoid this combination.
- Tramadol and DOxTramadol lowers the seizure threshold and psychedelics can cause seizures, so together a seizure becomes more likely. Avoid this combination.
- Tramadol and KratomTogether they add sedation and raise the risk of a seizure. Avoid this combination.
- Tramadol and LSDTramadol lowers the seizure threshold and psychedelics can cause seizures, so together a seizure becomes more likely. Avoid this combination.
- Tramadol and MescalineTramadol lowers the seizure threshold and mescaline can cause seizures, so together a seizure becomes more likely. Avoid this combination.
- Tramadol and MushroomsTramadol lowers the seizure threshold and psychedelics can cause seizures, so together a seizure becomes more likely. Avoid this combination.
- Tramadol and NBOMesTramadol lowers the seizure threshold and NBOMes can cause severe seizures. Avoid this combination.
- Tramadol and PregabalinTogether they raise the seizure risk and can knock you out. Avoid this combination at recreational doses. If someone passes out, put them on their…
Caution
3- Tramadol and AcetaminophenSome tramadol pills already contain acetaminophen. Check the label before adding Tylenol.
- Tramadol and MelatoninTogether they add sedation, and tramadol makes a rare serotonin reaction possible. Take less of each than usual.
- Tramadol and Nitrous OxideEach makes the other stronger, so you can lose balance or pass out without warning. Take less of each than usual, and do not use alone.
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.