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Updated: Jan 20, 2026

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Bleeding and Elevated INR Secondary to Concomitant Tramadol and Warfarin Administration
P & T : a Peer-Reviewed Journal for Formulary Management
|September 6, 2019
Summary
The drug interaction between tramadol and warfarin is not fully understood. This case study highlights the potential dangers when these medications are used together.
Area of Science:
- Pharmacology
- Clinical Medicine
Background:
- Warfarin is a widely prescribed anticoagulant.
- Tramadol is a commonly used analgesic.
Observation:
- A patient taking both tramadol and warfarin experienced an interaction.
- The interaction led to increased anticoagulation effects.
Findings:
- The precise mechanism of the tramadol-warfarin interaction remains unclear.
- This case demonstrates significant clinical risks associated with concurrent use.
Implications:
- Healthcare providers should exercise caution when prescribing tramadol to patients on warfarin.
- Further research is needed to elucidate the pharmacodynamic and pharmacokinetic basis of this interaction.
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