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A pressor response similar to the so-called “cheese effect” was noted in combinations of amphetamine and tramadol, which appears to cause dysfunction of or toxicity to epinephrine/norepinephrine receptors.[12][22] Cyclobenzaprine, a commonly-used muscle relaxant, atypical analgesic adjunct, as well as a potentiator often used with analgesics like codeine, dihydrocodeine, hydrocodone and the like, is structurally related to the tricyclic antidepressants [38] and therefore should not be used with tramadol; this is also the case for trazodone.[39]
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