Can you take cyclobenzaprine with tramadol?

In this article:

• Can you take tramadol and cyclobenzaprine together?
• Risks
• Precautions
• Interactions
• Uses
• Safety concerns

In this article

• Can you take tramadol and cyclobenzaprine together?
• Risks
• Precautions
• Interactions
• Uses
• Safety concerns

Cyclobenzaprine, known by the brand name Flexeril, is a muscle relaxant that can treat spasms, discomfort, and stiffness throughout the body, often from injuries. Tramadol is an opioid pain reliever used for treating severe pain. These two prescription drugs might seem like they’d go hand-in-hand, but taking them together can have a significant effect on the central nervous system, potentially leading to some serious side effects. Before combining medications, please continue reading for important information.

Can you take tramadol and cyclobenzaprine together?

In certain situations, it could be dangerous to take tramadol and cyclobenzaprine at the same time, so doctors often use them carefully, particularly for older adults. Because both drugs affect the central nervous system, they can have an additive effect when used together, according to Dr. Paul Daidone, MD, FASAM, medical director of True Self Recovery. “The concurrent use of tramadol and cyclobenzaprine is not outright contraindicated,” he says. “But it requires a cautious approach.”

Dr. John Lowe, MD of Restore Care Wellness Clinic agrees, stating, “Combining the synthetic opioid analgesic tramadol and cyclobenzaprine, a muscle relaxant, raises legitimate concerns due to possible additive central nervous system depression.” Central nervous system depression is when the body’s neurological processes slow down, affecting breathing, heart rate, blood pressure, and more. 

Higher doses often pose a higher risk, so “generally, doctors aim to start with the lowest effective dose for each medication to minimize the risk of adverse effects while still achieving therapeutic benefit,” Dr. Lowe says. However, “the specific dosage regimen can vary widely among patients, and it’s essential for healthcare providers to carefully assess and monitor each patient’s response to treatment to adjust the dosage as needed.”

The United States Drug Enforcement Agency has classified tramadol as a class IV controlled substance, which means it also has a risk (albeit a relatively low one) of abuse, dependence, and withdrawal symptoms. That’s why it’s most often used for the short-term treatment of acute pain. It’s not typically recommended for chronic pain, but healthcare professionals might still prescribe it for a longer duration of use in rare situations. 

So yes, technically, you can take them together, but only when a health care professional prescribes it. And you have to follow their instructions exactly. 

What happens if you take tramadol and cyclobenzaprine together?

As CNS depressants, both drugs significantly slow down certain central nervous system functions. Unlike many muscle relaxants, cyclobenzaprine acts directly on the brain stem rather than the muscles. Similar to some tricyclic antidepressants, it blocks certain motor neurons to help relieve muscle spasms. On the other hand, tramadol inhibits norepinephrine and serotonin reuptake while blocking certain opioid receptors to influence the body’s pain response. 

Together, those effects can produce some concerning adverse reactions. “The two drugs are both sedative agents, and, when taken concurrently, they will increase sedation, dizziness, weakness, or lack of balance,” says Dr. Lowe. “This can lead to more accidents occurring, especially among those groups who are vulnerable, such as older populations or those with other conditions.” 

Other central nervous system side effects may include:

• Slurred speech
• Difficulty breathing 
• Drowsiness 
• Reduced mental alertness 
• Mood changes 
• Slower heart rate
• Dry mouth 
• Constipation 
• Blurred or altered vision
• Allergic reaction 

For people who experience one or more of these reactions, the healthcare provider might recommend a dose adjustment or alternative medications.

But there is another risk of taking cyclobenzaprine and tramadol together. Dr. Daidone adds, “Concurrent use can also increase the risk of serotonin syndrome, a potentially life-threatening medical condition characterized by symptoms such as confusion, rapid heart rate, dilated pupils, fever, ataxia, stiff muscles, and more.” In certain rare cases, severe central nervous system depression from taking these drugs together may cause seizures, respiratory distress, coma, and even death. 

Precautions

Each drug has certain precautions that every patient and their healthcare provider should assess. It’s crucial for your healthcare provider to know your medical history, so before beginning cyclobenzaprine treatment, inform your care team if you’ve had:

• Cardiac issues like heart failure, irregular heartbeat, or heart block
• Overactive thyroid
• Glaucoma
• Liver disease
• Seizures
• Difficulty urinating

Because tramadol is a controlled substance, its list of precautions and warnings is even longer. Inform the healthcare provider if you currently have or have had:

• COPD (since it can cause serious breathing issues)
• Head injuries or brain tumors
• Seizures
• Recent heart attack or other heart problems
• Mental health conditions, including depression and addiction
• Blocking or narrowing of stomach/intestines or paralytic ileus
• Brain or spine infection
• Difficulty urinating
• Low sodium
• Diabetes
• Pancreas, gallbladder, or thyroid issues
• Kidney or liver disease
• Upcoming surgery

On top of all that, anyone taking these drugs should cut out the use of alcohol. Alcoholic beverages are also depressants. Avoid driving or operating hazardous machinery while taking these medications. People who are pregnant, breastfeeding, or planning on getting pregnant should inform their healthcare provider since the drugs might affect unborn children. 

Drug interactions

Cyclobenzaprine and tramadol both have major drug interaction warnings as well, most significantly with monoamine oxidase inhibitors (MAOIs) like Marplan and Nardil. Due to the seriousness of these interactions, cyclobenzaprine or tramadol should not be used within 14 days of taking MAO inhibitors. They may also interact with the following medicines: 

• Other muscle relaxants
• Other narcotic pain medicines
• Certain selective serotonin reuptake inhibitors (SSRIs)
• Other drugs that affect serotonin levels
• Medications for sleep or anxiety
• Azole antifungals
• Macrolide antibiotics
• Seizure drugs
• Certain nonprescription drugs like cough relievers or allergy medicines
• Some dietary supplements, natural products, or herbal products like St. John’s wort.

Inform your healthcare provider about all medicines and supplements you’re taking before beginning treatment. 

When would you need to take cyclobenzaprine and tramadol?

Despite the long list of possible interactions, cyclobenzaprine and tramadol aren’t totally incompatible. There are some specific situations where taking them together might be necessary. 

According to Dr. Lowe, those situations include “the management of musculoskeletal pain conditions such as muscle spasms and certain types of chronic pain. Additionally, this combination might be utilized in postoperative settings, particularly for surgeries associated with significant musculoskeletal pain or muscle spasm.”

That’s usually when someone hasn’t had adequate pain relief with one drug alone or other drugs have already been tried, adds Dr. Daidone. “The goal would be to use the lowest effective doses for the shortest duration possible, with careful monitoring for adverse effects,” he says. 

Each person is different, so “the decision to co-administer these medications should be made on a case-by-case basis,” according to Dr. Daidone. “Doctors should evaluate the benefits against the risks and consider the individual patient’s health status and concurrent medications.”

Is it safe to take tramadol and cyclobenzaprine? 

It can be, but only in specific circumstances under the close supervision of the prescribing healthcare provider. Both drugs depress the central nervous system, and even though they have different functions, they can cause some serious—even life-threatening—issues when taken together. That’s why it’s crucial never to self-medicate. Instead, follow the exact instructions of your healthcare provider and pharmacist and seek medical help if anything seems off.