What the FDA labels say about taking them together
Erythromycin and tramadol
Tramadol's FDA label of March 5, 2026 names erythromycin in its drug interactions section; the erythromycin labels PlainMeds reads (4) do not name tramadol. 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 erythromycin FDA label on DailyMed (effective August 1, 2024, Teva Pharmaceuticals USA, Inc.); the tramadol FDA label on DailyMed (effective March 5, 2026, Lupin Pharmaceuticals, Inc.).
What does the erythromycin label say about tramadol?
Erythromycin's label (effective August 1, 2024) and its 3 other brand-application labels do not name tramadol in these sections. A label lists what its studies and reports found; it is not a complete list.
Source: FDA drug label (Erythromycin), Teva Pharmaceuticals USA, Inc., effective August 1, 2024 (SPL set 75a0bd5a-d09f-483b-bfd8-f8343b149eb2), via openFDA; the full label on DailyMed
What does the tramadol label say about erythromycin?
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. … and evaluate patients for signs and symptoms of opioid withdrawal. Examples: Macrolide 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
| Erythromycin | Tramadol | |
|---|---|---|
| Labeled for | Bacterial infections, Acne | Pain |
| Boxed warning | No | Yes |
| Pharmacy cost (NADAC) | $1.96 per tablet 250 mg tablet | $0.0248 per tablet 50 mg tablet |
| Shortage now | No current entry | 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