Purchase Tramadol Serotonin syndrome – medicines* with described tramadol interactions **agents affiliated with serotonin syndrome (these may furthermore combine with tramadol) Warfarin Interaction • Some patients stabilized on warfarin may be at risk of an expanded INR, bruising, & bleeding after beginning normal doses of tramadol. Caution with PRN tramadol as well • This interaction seems to be affiliated with decreased CYP2D6 enzyme undertaking • Monitor INR when tramadol is begun or halted in patients taking warfarin, particularly in the first 3 to 4 days and until the INR is stable. Adjust warfarin dose accordingly Codeine is an alternate analgesic for patients in who tramadol is not advised. Optimising Medicines Bulletin Tramadol Interactions Reminderx