Tramadol and supplements: 3 sourced interactions
Opioid pain medicine, also sold as Ultram and ConZip. Of these, 3 named by an FDA label or NIH page. Plus 8 predicted from how each works (not established). Plus 1 food and drink line. Each links its source and the date it was checked.
From the Interaction Map Sources checked Oct 25, 2026
A combination missing here is not on our list; that does not mean it is safe together.
Tramadol with supplements
Most serious first. Open a row for the mechanism, the source's words and the date checked.
Educational only. Check with your pharmacist or prescriber before changing anything you take.
Moderate
4AshwagandhaLabel or NIHAn NIH page names this pair (cause not established).
moderate · Named by an FDA label or NIH page · Cause not established
In the source’s own words; rated moderate from that wording, not from a study of the pair.
“There is evidence that ashwagandha might interact with some medications, including those for diabetes and high blood pressure, medicines that decrease the immune system response (immunosuppressants), sedatives, anti-seizure medications (anticonvulsants), and thyroid hormone medications.”
- NIH National Center for Complementary and Integrative Health · Ashwagandha: Usefulness and Safety, What Do We Know About Safety?
- Checked Oct 23, 2026
KavaLabel or NIHAn NIH page names this pair (drowsiness).
moderate · Named by an FDA label or NIH page · Drowsiness
In the source’s own words; rated moderate from that wording, not from a study of the pair.
“Kava should not be used together with other substances that have sedative effects, such as benzodiazepines or alcohol.”
- NIH National Center for Complementary and Integrative Health · Kava: Usefulness and Safety, What Do We Know About Safety?
- Checked Oct 25, 2026
SAMeLabel or NIHAn NIH page names this pair (serotonin activity).
moderate · Named by an FDA label or NIH page · Serotonin activity
In the source’s own words; rated moderate from that wording, not from a study of the pair.
“It’s also possible that SAMe might interact with drugs and dietary supplements that increase levels of serotonin (a chemical produced by nerve cells), such as antidepressants, L-tryptophan, and St. John’s wort.”
- NIH National Center for Complementary and Integrative Health · S-Adenosyl-L-Methionine (SAMe): In Depth, Safety and Side Effects of SAMe
- Checked Oct 25, 2026
St John's wortPredictedSt John's wort may lower Tramadol levels and effect: it speeds up CYP3A, an enzyme that breaks Tramadol down.
moderate · Predicted from how each works, not established · Breakdown by liver enzymes
Predicted from what each is known to do, not studied as a pair and not established.
St John's wort may lower Tramadol levels and effect: it speeds up CYP3A, an enzyme that breaks Tramadol down.
Both add serotonin activity; together they can push it too high (serotonin syndrome).
- FDA table of drugs that interact with CYP enzymes · St John's wort: CYP3A strong inducer (Table 1, row "St. John’s wort", column "CYP Strg IND" (footnote 18: The effect of St. John’s wort varies widely and is preparation dependent.))
- FDA drug label (DailyMed) · Tramadol: CYP3A substrate (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 12.3)
- NIH National Center for Complementary and Integrative Health · St John's wort: adds serotonin activity (St. John’s Wort: Usefulness and Safety, What Do We Know About Safety?)
- FDA drug label (DailyMed) · Tramadol: adds serotonin activity (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 5.9)
- Checked Oct 25, 2026
Minor
7Asian ginsengPredictedBoth lower blood sugar, which may add up.
minor · Predicted from how each works, not established · Blood sugar lowering
Predicted from what each is known to do, not studied as a pair and not established.
Both lower blood sugar, which may add up.
- FDA drug label (DailyMed) · Tramadol: lowers blood sugar (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 5.21)
- NIH National Center for Complementary and Integrative Health · Asian ginseng: lowers blood sugar (Asian Ginseng: Usefulness and Safety, What Do We Know About Safety?)
- Checked Oct 25, 2026
BerberinePredictedBoth lower blood sugar, which may add up.
minor · Predicted from how each works, not established · Blood sugar lowering
Predicted from what each is known to do, not studied as a pair and not established.
Both lower blood sugar, which may add up.
- LiverTox (NIH) · Berberine: lowers blood sugar (Berberine. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury (NIDDK), Background)
- FDA drug label (DailyMed) · Tramadol: lowers blood sugar (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 5.21)
- Checked Oct 25, 2026
Cannabidiol (CBD)PredictedBoth can cause drowsiness, which may add up.
minor · Predicted from how each works, not established · Drowsiness
Predicted from what each is known to do, not studied as a pair and not established.
Both can cause drowsiness, which may add up.
- FDA drug label (DailyMed) · Tramadol: can cause drowsiness (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 5.2)
- NIH National Center for Complementary and Integrative Health · Cannabidiol (CBD): can cause drowsiness (Cannabis (Marijuana) and Cannabinoids: What You Need To Know, Can CBD be harmful?)
- Checked Oct 25, 2026
ChromiumPredictedBoth lower blood sugar, which may add up.
minor · Predicted from how each works, not established · Blood sugar lowering
Predicted from what each is known to do, not studied as a pair and not established.
Both lower blood sugar, which may add up.
- FDA drug label (DailyMed) · Tramadol: lowers blood sugar (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 5.21)
- NIH Office of Dietary Supplements · Chromium: lowers blood sugar (Office of Dietary Supplements · Chromium, Interactions with Medications · Metformin and other antidiabetes medications)
- Checked Oct 25, 2026
MelatoninPredictedBoth can cause drowsiness, which may add up.
minor · Predicted from how each works, not established · Drowsiness
Predicted from what each is known to do, not studied as a pair and not established.
Both can cause drowsiness, which may add up.
- NIH National Center for Complementary and Integrative Health · Melatonin: can cause drowsiness (Melatonin: What You Need To Know, Is it safe to take melatonin? > Safety concerns for older people)
- FDA drug label (DailyMed) · Tramadol: can cause drowsiness (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 5.2)
- Checked Oct 25, 2026
Potassium (supplements / salt substitutes)PredictedBoth lower blood pressure, which may add up.
minor · Predicted from how each works, not established · Blood pressure lowering
Predicted from what each is known to do, not studied as a pair and not established.
Both lower blood pressure, which may add up.
- FDA drug label (DailyMed) · Tramadol: lowers blood pressure (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 5.14)
- NIH Office of Dietary Supplements · Potassium (supplements / salt substitutes): lowers blood pressure (Office of Dietary Supplements · Potassium, Potassium and Health · Hypertension and stroke)
- Checked Oct 25, 2026
Red yeast ricePredictedBoth lower blood sugar, which may add up.
minor · Predicted from how each works, not established · Blood sugar lowering
Predicted from what each is known to do, not studied as a pair and not established.
Both lower blood sugar, which may add up.
Both lower blood pressure, which may add up.
- FDA drug label (DailyMed) · Tramadol: lowers blood sugar (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 5.21)
- NIH National Center for Complementary and Integrative Health · Red yeast rice: lowers blood pressure (Red Yeast Rice: What You Need To Know, Are red yeast rice products effective?)
- FDA drug label (DailyMed) · Tramadol: lowers blood pressure (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 5.14)
- Checked Oct 25, 2026
Tramadol with food and drink
Food and drink
1GrapefruitPredictedGrapefruit may raise Tramadol levels: it slows CYP3A, an enzyme that breaks Tramadol down.
moderate · Predicted from how each works, not established · Breakdown by liver enzymes
Predicted from what each is known to do, not studied as a pair and not established.
Grapefruit may raise Tramadol levels: it slows CYP3A, an enzyme that breaks Tramadol down.
- FDA table of drugs that interact with CYP enzymes · Grapefruit: CYP3A moderate inhibitor (Table 1, row "grapefruit juice", column "CYP Mod INH" (footnote 9: The effect of grapefruit juice varies widely among brands and is concentration-, dose-, and preparation-dependent. Studies have shown that it can be classified as a “strong CYP3A inhibitor” when a certain preparation was used (e.g., high dose, double strength) or more commonly as a “moderate CYP3A inhibitor” when another preparation was used (e.g., low dose, single strength).))
- FDA drug label (DailyMed) · Tramadol: CYP3A substrate (TRAMADOL HYDROCHLORIDE TABLET, FILM COATED [TEVA PHARMACEUTICALS USA, INC.], section 12.3)
- Checked Oct 25, 2026
How these lines are sourced
Three kinds of line
- Studied in people (PubMed): PubMed records that were opened and read, graded A (several controlled studies, or a finding in the dosing guidance), B (at least one controlled human study) or C (case reports, observational data or mechanism only).
- Named by an FDA label or NIH page: quoted word for word from that page. Its severity comes from the source’s wording, not from a study of the pair.
- Predicted from how each works, not established: built from sourced facts about each substance, such as the FDA’s table of enzyme roles. Never rated major.
Interaction MapCheck Tramadol with everything else you take, together
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- Interaction MapCheck several medicines and supplements at once, each interaction sourced to PubMed, FDA labels or NIH; a pair we have no source for reads as not on our list, never as safe.
- St. John's wortSt.