<p><strong>Respiratory depression:</strong>&nbsp;When large doses of tramadol are administered with anaesthetic with anaesthetic medications or alcohol, respiratory depression may result. Therefore, tramadol should be administered cautiously in patients at risk for respiratory depression.<br />
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<strong>Opioid dependence</strong>: Tramadol is not recommended for patients who are dependent on opioids.<br />
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<strong>Concomitant CNS depressants:</strong>&nbsp;Tramadol should be used with caution and in reduced dosages when administering to patients receiving CNS depressants such as alcohol, opioids, anesthetic agents, phenothiazines, tranquilizers or sedative hypnotics.<br />
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<strong>Concomitant MAO inhibitors</strong>: Tramadol should be used with great caution in patients taking MAO inhibitors, since tramadol inhibits the uptake of norepinephrine and serotonin.<br />
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Tramadol should be used with caution in patients with increased intracranial pressure or head injury and patients with acute abdominal conditions.</p>