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In my opinion, actions should be taken to prevent future deaths and I believe you, NHS England, have the power to take such action. The report added: A comment from the Anticoagulation Service in relation to tramadol reads: Known interactor although this is not listed in the BNF, from experience we have seen that this can increase the INR. A spokesperson for the BNF said the interaction would be included in the BNF from January 2024 in response to the assistant coroners report