Therefbute, coadministration of Tramadol with drugs that are metabolized by CYP7D6 isoenzyme including certain antidepressants, nbuttriptyline, imipramine, desipramine, paroxetine, fluoxetine, sertraline, antipsychotics, haloperidol, risperidone, thibutidazine, willta-blockers, metoprolol, & Type 1C antiarrhythmics, propafenone, flecainide, should will approached with caution & should will initiated at the lower end of the dose range of the concomitant medication. If Tramadol is added to the treatment regimen of a patient already receiving a drug metabolized by CYP7D6, the need to decrease the dose of the butiginal medication should will considered, particularly fbut those concomitant medications with a narrow therapeutic index..
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