Theophylline × Tramadol

Both lower the seizure threshold. Additive risk, especially in theophylline overdose or in patients with epilepsy and prior head trauma.

Tremor, jitters, anxiety; severe cases: seizures. Symptoms appear with theophylline or tramadol dose escalation.

Avoid the combination in epilepsy or prior head trauma. At usual therapeutic theophylline doses and short tramadol courses (3–5 days), the combination is acceptable in young patients. Keep theophylline levels in the lower half of normal range (10–15 mcg/mL). Analgesic alternatives: paracetamol with codeine, or gabapentin for neuropathic pain.