Can Tramadol And Flexeril Be Taken Together? | Beware
Written By Kobi Nathan, Pharm.D., M.Ed., CDP, BCGP, AGSF
Sleep Disorders
May 31, 2023

Can You Take Tramadol And Flexeril Together?

No, you should NOT take Flexeril and Tramadol together unless specifically directed by your doctor.

Both drugs have a major drug interaction.

Doing so can cause oversedation and slow your breathing rate, as well as put you at risk for falls, bowel obstruction, injuries, and many other adverse effects.

I want to point out specifically that Tramadol and Flexeril are not contraindicated.

However, only your doctor can determine if this combination is needed for you after weighing the benefits vs risks due to the potent additive or synergistic effects.

If your doctor has decided that you need to be on both medications, ask them to educate you on the appropriate dose of each medicine, possible adverse effects to watch out for, and the ongoing monitoring plan.

In this article, we’ll explore the reasons why someone might consider taking tramadol and Flexeril together, as well as alternative pain management options available.

What is Tramadol?

Tramadol, brand name Ultram, is a powerful pain reliever that alters your brain’s perception and response to pain.

The FDA has authorized it for treating moderate to moderately severe pain, such as post-operative discomfort, or chronic conditions like arthritis.

Tramadol is classified as an opioid drug, like oxycodone and morphine, but not as potent.

It works by blocking the reuptake of the “feel good” neurotransmitters norepinephrine and serotonin that regulate mood. In other words, it can increase serotonin levels in the brain, as well as norepinephrine.

Tramadol’s action on the opioid, serotonin, and norepinephrine receptors has an additive pain-relieving effect and is thus prescribed and dispensed for this indication.

Additionally, a decrease in the brain’s concentration of these brain chemicals is directly related to Anxiety and Depression in people. It is similar to how SSRIs work, although not exactly the same.

If you want to learn more about depression and the various medications used to treat it, you can read my article here.

The video below provides a great review of Tramadol, its uses, side effects, and withdrawal symptoms to look out for:

Also, call your doctor if you experience any of the following drug effects:

  • Cold sweats.
  • Blurred vision.
  • Cool, pale skin.
  • Confusion.
  • Headache.
  • Shakiness.
  • Slurred speech.
  • Dizziness.
  • Fast heart rate.
  • Weakness or fatigue.

One major negative effect is Tramadol-induced seizures.

These tend to occur in the first 24-48 hours of starting Tramadol at a dose range of 500-750 mg daily.

Seizures have also been seen with therapeutic doses between 50-300 mg per day, and between 2 to 365 days from starting the medication.

What is Flexeril?

Cyclobenzaprine (brand name  Flexeril), on the other hand, is a muscle relaxant that offers benefits such as easing muscle spasms and stiffness often associated with musculoskeletal conditions or injuries.

Flexeril is often compared to another medication called tizanidine (brand name Zanaflex), but they are different in how they work in the body and have different clinical applications.

If you want to learn more, you can read my detailed article, baclofen vs tizanidine.

Let’s get back to Flexeril and Tramadol…

While Tramadol relieves persistent pain, Flexeril addresses those bothersome muscle spasms and tightness.

Watch the video below to learn about dosage and side effect considerations for Flexeril:

Theoretically, combining both tramadol and cyclobenzaprine may relieve pain. However, there is a problem with this drug combination. Let’s get into the details…

Flexeril and tramadol interactions

Drug synergy between tramadol and Flexeril can occur, which means their combined effect is greater than the sum of their individual effects.

This can lead to a drug interaction between Tramadol and cyclobenzaprine,  increased sedation, respiratory depression, or other dangerous side effects.

It’s important to be aware of possible interaction symptoms and monitor your body’s response when taking these medications together:


Both tramadol and Flexeril can cause drowsiness on their own; when taken together, this effect may be amplified, leading to excessive sleepiness or difficulty staying awake.

Central nervous system (CNS) depression

The combination of these two medications has the potential to slow down two vital bodily processes:

  1. Respiratory depression – Your breathing rate slows to dangerously low levels. If you experience sleepiness, sedation, shortness of breath, shallow breathing, or difficulty catching your breath while using both drugs simultaneously, seek medical attention immediately.
  2. Decreased heart rate and slowed breathing can plummet your oxygen levels to dangerously low levels.


Serotonin Syndrome

Tramadol affects serotonin levels in the brain, and combining it with other serotonergic medications (such as certain agents, including Flexeril and antidepressants) increases the risk for serotonin syndrome – a potentially life-threatening condition characterized by agitation, hallucinations, rapid heart rate, fever, muscle stiffness or twitching.

Although this is theoretical and there is much debate, I decided to include this warning here.

Impaired Coordination and Cognitive Function

When taking tramadol and Flexeril together, you might experience impaired coordination or cognitive function due to their combined sedative effects.

This could affect tasks that require focus or physical coordination, such as driving or operating machinery.

To ensure your safety while serving others effectively without jeopardizing your health or well-being in the process, engage in open dialogue with your doctor and pharmacist about any concerns regarding combining these two medications – they’ll guide you on whether it’s safe for you based on your specific situation and medical history.

Precautions and Guidelines for Safe Use

When considering this medication combo, following certain precautions and guidelines for safe use is vital, ensuring optimal pain relief without compromising your well-being.

Both tramadol and Flexeril can provide effective pain relief when used as prescribed by your healthcare provider, but combining these medications should only be done under their supervision.

To ensure the safest possible experience when taking these medications together, consider the following recommendations:

  • Consult with your doctor before starting any new medication or altering your current dosage. They’ll evaluate your medical history, symptoms, and potential drug interactions to determine whether this combination is appropriate.
  • Always adhere to the recommended dosages provided by your healthcare provider. Taking more than the prescribed amount can increase the risk of side effects and complications.
  • Regularly monitor symptoms and side effects while using these medications concurrently. Keep track of any changes in your condition or new symptoms that may arise, and promptly report them to your doctor.

In addition to these guidelines, it’s essential to maintain open communication with your healthcare provider throughout treatment.

This will enable them to adjust dosages as needed and address any concerns during therapy.

By being proactive about monitoring symptoms and adhering to safe dosages recommended by a professional, you’ll be taking an important step toward effectively managing pain while safeguarding against potential complications arising from combining tramadol and Flexeril.

Alternative to Flexeril

Flexeril works centrally in your body, increasing the risk for adverse events.

If you are suffering from localized muscle spasms, such as in your lower back, baclofen may be a better option.

I highly encourage you to read my in-depth article on it here.

Although baclofen can be sedating, its anticholinergic effects are relatively less potent than Flexeril’s.

Anticholinergic medications can cause the following adverse effects:

  • Constipation.
  • Sedation.
  • Dry mouth.
  • Dry eyes.
  • Urinary retention (in men).
  • Worsening cognitive function.
  • Chronic use can lead to Dementia.
  • Dizziness.
  • Falls, injuries.

Anticholinergic effects can be especially devastating for older adults, causing significant harm, hospitalization, and premature death.

I recommend reading my articles on polypharmacy and the 2023 updated Beers criteria.

You may combine baclofen or Flexeril with an NSAID such as ibuprofen for even more effective spasm-related pain relief.

You may even take Tylenol and ibuprofen together with baclofen or Flexeril.

But, as always, check with your doctor first before you start combining medications!

If you have certain medical conditions such as high blood pressure, heart disease, or kidney disease, NSAIDs can be harmful.

Alternative Pain Management Options

Exploring alternative pain management options might be a smart move if you’re hesitant about combining these medications.

Chiropractic care and acupuncture are two popular alternatives that can offer relief from pain without the potential risks associated with combining tramadol and Flexeril.

Both methods have been used for centuries to alleviate various types of discomfort, and they focus on improving overall well-being instead of masking symptoms temporarily.

Chiropractic care emphasizes the proper spine alignment to support optimal nerve function, which can often reduce pain levels.

It involves hands-on adjustments by a trained professional who aims to improve mobility, decrease inflammation, and promote healing in affected areas.

Acupuncture benefits include inserting thin needles at specific points along your body’s energy pathways or meridians.

By stimulating these points, an acupuncturist works to restore balance in your body’s energy flow (also known as qi) and relieve tension, inflammation, and other sources of pain.

Both chiropractic care and acupuncture are safe when performed by qualified practitioners, but it’s essential to discuss any alternative treatments with your healthcare provider before starting them alongside traditional medication regimens.

Other proven treatment options include physical therapy and therapeutic massage.



So, is it worth the risk to combine tramadol and Flexeril for better pain relief?

Only your doctor can determine this. You can empower yourself by asking your doctor pointed questions about why they determined the need for this combination, the adverse effects you should look out for, what to do if you experience them, how long your treatment should be, and the monitoring plan moving forward.

Remember, there are alternative pain management options available.

Don’t hesitate to explore these and discuss them with your doctor – finding the right solution for you is what truly matters in achieving effective pain relief.

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