Diazepam × Tramadol

Tramadol is a weak opioid with additional serotonin–norepinephrine reuptake inhibition. With diazepam, the risk is doubled: additive CNS and respiratory depression plus a lowered seizure threshold (tramadol provokes seizures on its own).

Drowsiness, slowed breathing. Seizures may occur, especially in patients with prior epilepsy or with dose excess. Serotonin syndrome is less common unless other serotonergics are added.

Avoid where possible. If unavoidable, minimal doses of both and a short course. Alternative analgesia: paracetamol with an NSAID; alternative anxiolytics: gabapentinoids or hydroxyzine.