Drug Safety Update - Warfarin: be alert to the risk of drug interactions with tramadol

8th Jul 2024

Medicines and Healthcare products Regulatory Agency (MHRA) has published an article in the Drug Safety Update (DSU) to remind healthcare professionals to be alert to the risk of harmful drug interactions between Warfarin and Tramadol.

This risk is due to a harmful drug interaction which may lead an increase in the International Normalised Ratio (INR), with a risk of major bruising and bleeding in some patients which could be life-threatening. 

We have received a Coroner’s report following the death of a patient who died from a bleed on the brain, following concurrent treatment with warfarin and tramadol. Taking warfarin and tramadol together can cause harmful drug interactions which may increase a patient’s INR and increase the risk of bleeding.

The coroner raised concerns that the interaction between warfarin and tramadol was not well known and emphasised the need to highlight this interaction to healthcare professionals.

For more information, please read the DSU advice for healthcare professionals, patients and carers. 

Healthcare professionals, patients, and caregivers are asked to report suspected reactions on a Yellow Card.