What the FDA labels say about taking them together
Ritonavir and tramadol
Ritonavir's FDA label of July 23, 2026 names tramadol in its drug interactions section, and tramadol's label names ritonavir too. The tramadol label: “The concomitant use of Tramadol Hydrochloride Extended-Release Capsules and CYP3A4 inhibitors can increase the plasma concentration of tramadol and may result in a greater amount of metabolism via CYP2D6 and greater …”
Check it at the source: the ritonavir FDA label on DailyMed (effective July 23, 2026, AbbVie Inc.); the tramadol FDA label on DailyMed (effective March 5, 2026, Lupin Pharmaceuticals, Inc.).
What does the ritonavir label say about tramadol?
Ritonavir label, drug interactionsConcomitant Drug Class/Drug Name: Analgesics, Opioid: tramadol, propoxyphene, methadone, fentanyl; Effect on Concentration of Ritonavir or Concomitant Drug: ↑ analgesics ↓ methadone ↑ fentanyl; Clinical Comment: A dose decrease may be needed for these drugs when co-administered with ritonavir. Dosage increase of methadone may be considered. Careful monitoring of therapeutic and adverse effects (including potentially fatal respiratory depression) is recommended when fentanyl is concomitantly administered with NORVIR.
Source: FDA drug label (Norvir), AbbVie Inc., effective July 23, 2026 (SPL set 2849298e-de6e-47bb-8194-56e075b33fc3), via openFDA; the full label on DailyMed
What does the tramadol label say about ritonavir?
Tramadol label, drug interactionsIf a CYP3A4 inhibitor is discontinued, consider increasing the tramadol hydrochloride extended-release tablets dosage until stable drug effects are achieved and evaluate patients at frequent intervals for signs and symptoms of opioid withdrawal. Examples Macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g. ketoconazole), protease inhibitors (e.g., ritonavir) CYP3A4 Inducers
Tramadol label, warnings and precautionsCytochrome P450 3A4 Interaction The concomitant use of tramadol hydrochloride extended-release tablets with cytochrome P450 3A4 inhibitors, such as macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), and protease inhibitors (e.g., ritonavir) or discontinuation of a cytochrome P450 3A4 inducer such as rifampin, carbamazepine, and phenytoin, may result in an increase in tramadol plasma concentrations, which could increase or prolong adverse reactions, increase the risk for serious adverse events including seizures and serotonin syndrome, and may cause potentially fatal respiratory depression.
Tramadol Hydrochloride Extended-Release label (Trigen Laboratories, LLC, January 23, 2026), drug interactionsInhibitors of CYP3A4 Clinical Impact: The concomitant use of Tramadol Hydrochloride Extended-Release Capsules and CYP3A4 inhibitors can increase the plasma concentration of tramadol and may result in a greater amount of metabolism via CYP2D6 and greater levels of M1. … antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), protease inhibitors (e.g., ritonavir)
Source: FDA drug label (Tramadol Hydrochloride Extended-Release, NDA022370), Trigen Laboratories, LLC, effective January 23, 2026 (SPL set c0bc7218-3fd0-4646-96f4-25355fc84aa9), via openFDA
Source: FDA drug label (TRAMADOL HYDROCHLORIDE), Lupin Pharmaceuticals, Inc., effective March 5, 2026 (SPL set 46bb9ae6-3ee8-463c-badb-c7a45a89b84b), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Ritonavir | Tramadol | |
|---|---|---|
| Labeled for | HIV | Pain |
| Boxed warning | Yes | Yes |
| Pharmacy cost (NADAC) | $0.607 per tablet 100 mg tablet | $0.0248 per tablet 50 mg tablet |
| Shortage now | A presentation being discontinued | No current entry |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once