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Concomitant use or discontinuation of CYP450 isoenzymes which include CYP450 3A4 inducers, CYP450 3A4 inhibitors, or CYP450 2D6 inhibitors are advanced; concomitant use involves thorough consideration on the effects to the guardian drug, tramadol, and the Lively metabolite, M1. This exercise empowers clinicians to properly immediate client therapy