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Is It Safe to Combine Diazepam and Tramadol?

By Sandi Johnson
Updated Jun 04, 2024
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In terms of drug interactions, the combination of diazepam and tramadol is considered by most medical professionals to have moderate risks and therefore should be avoided when possible. Diazepam, a benzodiazepine, is used in the treatment of anxiety disorders and as a additional medication used in the treatment of seizures. Tramadol, a pain medication similar to narcotics, is used to treat severe or chronicle pain. Many side effects for these medications are the same, so combining them increases the likelihood or severity of occurrences. The risks associated with diminished alertness, seizures, difficulty breathing and a depressed central nervous system are of primary concern.

Side effects such as sleepiness, dizziness and an overall diminished sense of alertness are common to both diazepam and tramadol. Drowsiness and mild dizziness are common side effects for many medications, but combining two medications with similar effects typically intensifies the resulting side effects. As such, patients who must maintain a treatment regimen that involves taking both of these medicines should exercise extreme care when driving, operating heavy equipment or doing other activities that require alertness.

Aside from increased drowsiness, taking diazepam and tramadol can also depress the central nervous system. Symptoms of a depressed central nervous system include slurred speech, blurred vision, reduced pain response, a staggered gait, poor coordination and other symptoms similar to intoxication. Initially, patients might feel only increased sleepiness, but continued treatment can depress other central nervous system functions, making it difficult for the patient to complete daily activities. Severe central nervous system depression can lead to eventual coma and other, more serious complications.

The warnings for both diazepam and tramadol include an increased risk of seizures. For individuals who have a history of head trauma, seizure disorders and certain types of metabolic disorders, the risks of a seizure while taking either tramadol or diazepam is considerably higher. Treatments that involve the use of both of these medications are widely considered to pose a medically unacceptable risk of seizure, especially in patients who have a predisposition to seizures.

Respiratory system depression is another risk that is associated with combining tramadol and diazepam or other similar medications that have sedative properties. Each medication separately lists difficulty breathing as a possible serious side effect. Concomitant use of these medications synergistically increases the risks associated with a depressed respiratory system. The patient's inhaling and exhaling slows, resulting in increased carbon dioxide and decreased oxygen in the bloodstream. Some cases of respiratory depression can, in worst-case scenarios, lead to complete respiratory arrest, brain damage or even death.

Although classified individually as moderately risky, the use of tramadol and diazepam simultaneously is exceptionally risky for certain patients. People who have a history of seizures, cardiovascular or kidney disease, asthma and other breathing difficulties or a drug or alcohol addiction are strongly advised against concomitant use. When combined usage is unavoidable, close monitoring by medical professionals is strongly recommended.

How to Get Tramadol Out of Your System

Many people believe drinking water and exercising will allow you to sweat medicine out of your system faster. However, if you're trying to flush out tramadol to take diazepam, these actions won't help you metabolize the tramadol more quickly.

You have to wait to allow your body time to break down and process the medication before it will eliminate the tramadol. If you believe you've taken too much of the drug, naloxone can help stave off dangerous respiratory effects. Scientists have found that the most effective way to get tramadol out of your system is, ironically, through a combination of naloxone and diazepam

How to Get Diazepam Out of Your System

You should allow diazepam to progress through your system naturally if possible. It's essential to take precautions if you're trying to get this substance out of your system to take tramadol. Depending on how long you've been using diazepam, there's always the chance that your body will respond negatively if you suddenly stop taking it. 

It takes approximately ten days to get Diazepam out of your system. The drug is fast-acting and long-lasting, so ensure that it is out of your system before taking medicine like tramadol if you haven't consulted with a physician. 

In severe cases, you may experience some adverse side effects even if you haven't taken diazepam for a few days before taking the tramadol. You may encounter nausea, headaches, shivering, and other withdrawal symptoms if your body has become dependent on the drug or if it has remained in your system. 

Drug Interactions

Though there are some medications that you shouldn't use together, no matter what, you can use many substances simultaneously without dangerous interactions. Though tramadol and diazepam will react poorly, there may be other options for you to use in order to control your symptoms. 

If you need both of these medications, ask your doctor if it's possible to take them in a way that doesn't adversely affect your health. You can also ask your doctor to change the doses for lower side effects. If they advise against it, however, do not attempt to take both drugs together. 

When To Contact The Doctor

Contact your doctor if you are experiencing restlessness, nausea, diarrhea, vomiting, muscle spasms, fever, twitching, a fast heartbeat, or if you hear or see things that are not there. These symptoms may have to do with a condition called serotonin syndrome. If you are taking other medicine that affects serotonin levels in your body, you may have a higher risk of getting this serious condition.

The medicine to combat this particular syndrome may cause you to be irritable or to exhibit other abnormal behaviors. The treatment can cause you to become more depressed or to have suicidal ideation, so make sure that everyone involved in your medical care knows if you are taking tramadol or diazepam.

Additional Side Effects

If you wake up easily, have trouble going to sleep, become restless, or have a massive increase in energy, notify your doctor immediately. Additionally, consult emergency services if you begin to have any strong or sudden feelings of being violent, scared, angry, nervous, or restless.

If you or anyone in your family has tried to commit suicide or has bipolar disorder, be sure to disclose this information to your doctor. They may prescribe you a different medication to avoid negative side effects. 

These medicines can cause severe allergic reactions, including angioedema, anaphylaxis, or skin conditions such as epidermal necrolysis. These reactions require immediate medical attention as they can be life-threatening. Call your doctor immediately if you have skin that is blistering, itching, peeling, loosening, or forming a rash. 

Likewise, if you develop chills, red, irritated eyes, a cough, or red skin lesions, contact your physician immediately. You can also suffer from ulcers, sores, sore throat, difficulty swallowing or breathing, white spots in the mouth, swelling of the hands, face, mouth, or throat, and severe tiredness or weakness when using these medications together.

Knowing the potential risks of taking a specific medication is vital to your health and well-being. If you have any questions about these drugs, or questions about your medication in general, visit your primary care physician or a local pharmacy for advice.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Discussion Comments
By anon952460 — On May 21, 2014

While the article above has many inaccuracies, one thing that was mentioned which has some indirect truth to it is using both diazepam with tramadol can cause an increase in certain negative side effects. In most people without any type or history of seizures, using tramadol by itself, in of course therapeutic ranges, doesn't pose any further increase in seizure activity. However, anyone with a history of seizures shouldn't be taking tramadol to begin with.

Tramadol not only has pain killing effects, but acts on norepinephrine and serotonin. Diazepam, interestingly enough, isn't a benzodiazepine that has activity on serotonin. Therefore, while it will increase and synergize potentially the effects of tramadol and vice versa, this doesn't mean that it would not pose a threat to those with a history of seizures.

Diazepam, while it is a fast acting benzodiazepine, does not possess long acting therapeutic activity (its metabolites are what keeps it in one's system for so long) If anything, as contradictory as sounds, a benzodiazepine like clonazepam, which does possess strong initial anticonvulsant activity may actually pose more problems when taken with tramadol. The reason is that clonazepam, it is recognized, acts on decreasing serotonin. By doing this, those who suffer from depression would be at greater risk in mixing it with a pharmacological agent like tramadol.

Tramadol, which could have mood stabilizing, anti-depressant effects, could lose some efficacy if taken for awhile with clonazepam to counter seizures. Along with that fact, going back to specific dosages, if one were to take too much tramadol versus the clonazepam, you are now talking about withdrawals off both medications, which acting synergistically now could possibly lower one's seizure threshold.

In conclusion, taking tramadol with clonazepam in those not prone to seizures seems fairly safe (although pointless when taking tramadol in the therapeutically acceptable range). Unlike taking diazepam with tramadol, which could increase the euphoric effects, clonazepam not only would decrease tramadol's anti-depressant activity, but could negatively interact with tramadol if taken for longer periods of time and not understanding dose by dose of both agents.

By anon328804 — On Apr 05, 2013

You're wrong about the combination of diazepam and tramadol increasing the risk of seizures: tramadol does reduce the seizure threshold but diazepam inhibits seizures to a great effect.

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