Skip to main content
Drug Info

Can you take tizanidine and tramadol together?

Discover the dangers of combining tizanidine and tramadol, including severe side effects like respiratory depression and dizziness.
Wendy Wisner
By | Updated on Jan. 2, 2025 Medically reviewed by J. Elizabeth Allen, DO, FACEP
Rx pills comparing tizanidine and tramadol

Key takeaways

  • Tizanidine is a muscle relaxant, and tramadol is a strong opioid painkiller.

  • Both tizanidine and tramadol are central nervous system depressants, meaning that they can cause fatigue, decreased blood pressure, and dizziness.

  • Combining these medications can increase side effects like fatigue, and may even cause breathing issues or death in some cases.

  • Although some providers may prescribe tizanidine and tramadol together for people who have muscle spasms and pain, they are generally not prescribed together due to adverse side effects.

In this article:

Tizanidine, sold under the brand name Zanaflex, is a skeletal muscle relaxant that works by decreasing activity in the brain and nervous system, causing the muscles to relax. Tizanidine is classified as a centrally acting alpha-2 agonist and is FDA approved to treat muscle spasms due to multiple sclerosis, spinal cord injuries, traumatic brain injuries, and amyotrophic lateral sclerosis. Off-label uses include chronic lower back pain, neck pain, migraines, headaches after analgesic withdrawal, insomnia, and regional muscle pain.

Another medication that is frequently used for skeletal muscle issues is tramadol, a medication sold under the brand name Ultram. Unlike tizanidine, tramadol doesn’t help with muscle spasms, but with overall pain in the body. Tramadol is an opioid and is FDA approved to treat moderate to severe pain, including muscle pain. Like other opioids, tramadol has the potential to be highly addictive and misused, which is why it’s classified as a class IV controlled substance.

If you are dealing with muscle spasms along with muscle pain or pain elsewhere in your body, you might want to know: Can you take tizanidine and tramadol together? The answer is that taking tizanidine and tramadol together can lead to serious and even deadly side effects, including but not limited to: slowed or stopped breathing, excessive sleepiness, dizziness, and low blood pressure.

While combining tizanidine and tramadol might make sense in certain circumstances, you should only take these medications together under the strict supervision of your doctor.

Read on for more information about taking tizanidine and tramadol together, including interactions, safety concerns, and timing of doses.

Can you take tizanidine and tramadol together?

Whether or not to take tizanidine and tramadol together is a common query among people who have muscle spasms and pain. “As a spine and pain management doctor, I often see patients dealing with complex pain issues, and the question of combining medications like tizanidine and tramadol comes up frequently,” says Taher Saifullah, MD, pain management specialist and founder of Spine & Pain Institute Los Angeles.

Unfortunately, while it’s possible to combine these two medications in some circumstances, it’s not generally recommended. This is because of the potentially dangerous side effects of combining tizanidine and tramadol.

Both tizanidine and tramadol can cause central nervous system depression, and these effects become amplified if you combine them, says Arthur Shektman MD, a board-certified plastic surgeon at the Gynecomastia Center of Boston who often prescribes tramadol for post-surgical pain. “Both medications can cause sedation, dizziness, and low blood pressure, so their combined effects could pose significant risks if not managed properly,” Dr. Shektman describes. The most serious of these risks is that someone could stop breathing.

There are certain circumstances where a physician may decide that this combination is a good idea. “If you’re dealing with both muscle spasms and pain, your doctor might decide that the combination is worth trying, but it should be done with caution,” Dr. Saifullah says. “Your doctor will weigh the benefits against the potential risks, considering factors like your overall health, the reason you’re taking the medications, and any other conditions you might have.”

Dr. Saifullah says that people with underlying issues like liver or kidney disease might be more likely to experience serious side effects when combining tizanidine and tramadol. This combination might cause people with underlying liver or kidney disease to experience more extreme lightheadedness. In some cases, can cause difficulty or slowed breathing that can, in the worst-case scenario, result in death.

Benefits of taking tizanidine and tramadol at the same time

Although most physicians are hesitant to prescribe tizanidine and tramadol together, there are some potential benefits that can result from this combination.

As Dr. Shektman notes, tramadol is used for pain relief, while tizanidine is a skeletal muscle relaxant. “Theoretically, they can be combined to treat conditions involving both significant pain and muscle spasms, such as after surgery or an injury,” he explains. “But the risks outweigh the benefits in most circumstances.”

According to Dr. Saifullah, there are certain situations where combining these two drugs can be useful. “For example, if you’re experiencing both muscle spasms and nerve or joint pain, combining these two drugs might offer more comprehensive relief,” he says. “Tizanidine works as a muscle relaxant, helping to ease muscle tightness and spasms, while tramadol targets pain through a combination of mechanisms, affecting both the central nervous system and your body’s pain receptors.”

In other words, taken together, tizanidine and tramadol can provide better overall symptom relief than either would on its own.

Tizanidine and tramadol risks and interactions

Both tizanidine and tramadol can produce strong side effects. For example, common side effects of tizanidine include dizziness, fatigue, overall weakness, anxiety, depression, and nausea. Tramadol is an opioid, and in addition to side effects like sleepiness, mood changes, headaches, nervousness, dry mouth, and indigestion, tramadol is known to be addictive and is often misused.

When you combine drugs that have similar side effects, including fatigue and mood changes, these side effects tend to be more intense than if you took each drug on its own. “The biggest concern with taking these two medications together is the risk of excessive sedation and dizziness,” Dr. Saifullah says. Side effects like excessive drowsiness “could make daily activities like driving or even standing up feel unsafe,” he describes. People who experience drowsiness while taking these medications should never drive or operate heavy machinery.

The other major concern when it comes to combining tizanidine and tramadol is respiratory issues. “Both drugs affect the central nervous system, so there’s a risk of respiratory depression—meaning your breathing could slow down too much, which can be dangerous,” Dr. Saifullah warns.

Certain populations should take extra precautions, or avoid this drug combination altogether. This includes individuals with a history of breathing problems or heart issues, Dr. Saifullah explains. Combining tizanidine and tramadol can worsen these medical conditions.

How long after taking tizanidine can you take tramadol?

There are no formal guidelines for taking tizanidine with tramadol together. If your provider thinks combining these drugs is safe and a good idea for you, they will give you specific instructions on how to do this.

In general, Dr. Saifullah says spacing the two medications out is helpful in terms of minimizing side effects. “There’s no magic number, but generally speaking, spacing them out by a few hours can allow your body to process each drug separately, reducing the chances of feeling overly sedated or dizzy,” he says, emphasizing that it’s always best to follow the timing and dosage recommendations from your healthcare provider.

Dr. Shektman agrees with this approach. In his practice, Dr. Shektman recommends patients space out these medications. “Generally, I would recommend staggering the medications by four to six hours to avoid compounding effects.”

What medications should you not mix with tizanidine or tramadol? 

There are other medications you should use with caution if you are taking either tizanidine or tramadol.

When it comes to tizanidine, you should avoid any other medications or substances that slow down your nervous system, including benzodiazepines (for anxiety or sleep), and alcohol Dr. Saifullah says. Also, marijuana/cannabinoids, or Kratom. According to DailyMed at the National Institutes of Health, the following medications should never be combined with tizanidine:

You should also take precautions and speak to your healthcare provider before taking other CYP1A2 Inhibitors like zileuton or antiarrhythmics like mexiletine, amiodarone, propafenone, or beta blockers. You should talk to your provider before combining tizanidine with oral contraceptives, as well as any central nervous depressant.

There are also medications you should avoid if you are taking tramadol. As DailyMed at the National Institutes of Health notes, the following medications aren’t recommended for people taking tramadol:

In addition, medications to be cautious with combining with tramadol include:

Medications that increase serotonin like selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), antihistamines, and tricyclic antidepressants (TCAs)

What medications can you take with tizanidine?

What about medications that you can take with tizanidine? First, it’s important to keep in mind that when you are taking a prescription medication like tizanidine, you should discuss any other medications you are taking with your healthcare provider. They are the best resource for this.

The good news is that many common household medications are safe to combine with tizanidine. Dr. Shektman shared that the following medications are generally safe:

Many people also want to know if they can combine with antidepressants. While there are no guidelines that prohibit combining tizanidine with antidepressants specifically, you should seek medical advice from your healthcare provider if you are taking antidepressants.

Sources