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Some individuals are susceptible to interaction between tramadol and warfarin. The Australian Drug Reactions Advisory Committee (ADRAC) has received 11 reports of this interaction leading to an increase in INR (international normalized ratio) or a haemorrhagic event. The median onset time after addition of tramadol to stabilized warfarin therapy was 4 days. Five reports describe rapid recovery within 1-4 days of withdrawal of tramadol with or without reduction in the dose of warfarin. Two patients, aged 76 and 88 years, died of haemorrhagic stroke. In one of these patients, both tramadol and warfarin were...