MHRA Alert – Warfarin and Tramadol: Critical Drug Interaction Risk

Important Safety Alert

The MHRA has issued a safety alert regarding a significant drug interaction between warfarin and tramadol. This combination can cause harmful interactions that elevate the International Normalised Ratio (INR) and result in severe bruising, bleeding, and in some cases, fatal outcomes.

Key Points

• Warfarin and tramadol together increase the risk of serious bleeding complications
• The interaction can raise INR to dangerous levels
• Patients may present with severe bruising and uncontrolled bleeding
• Clinical outcomes can be life-threatening if not managed promptly

Affected Medications

• Warfarin (anticoagulant)
• Tramadol (opioid analgesic)

Recommended Actions

• Review patient medications at every opportunity, particularly those on warfarin
• Be alert to tramadol prescriptions or over-the-counter use in warfarin-treated patients
• Consider alternative analgesia where possible
• If co-prescription is unavoidable, increase INR monitoring frequency
• Educate patients on the risks and advise them to report any unusual bruising or bleeding immediately

Further Information

For the full MHRA drug safety update, visit the MHRA website.