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Concomitant use or discontinuation of CYP450 isoenzymes which includes CYP450 3A4 inducers, CYP450 3A4 inhibitors, or CYP450 2D6 inhibitors are complicated; concomitant use involves mindful consideration of the effects within the father or mother drug, tramadol, as well as Energetic metabolite, M1.Carbamazepine. Having this medication with tramadol