Posted by Phillipa on July 21, 2009, at 12:10:32
In reply to Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 21, 2009, at 4:50:17
Well I'll be darned!!!! Per drug checker. Phillipa
Multi-Drug Interaction Checker
Patient RegimenULTRAM ORAL
ZOLOFT ORAL
InteractionsSevere Interaction
TRAMADOL/SSRI'S; DULOXETINE; VENLAFAXINE
Ultram Oral and Zoloft Oral may interact based on the potential interaction between TRAMADOL and SSRI'S; DULOXETINE; VENLAFAXINE.Tramadol/Selective Serotonin Reuptake Inhibitors; Duloxetine; Venlafaxine
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
MONOGRAPH TITLE: Tramadol/Selective Serotonin Reuptake Inhibitors;Duloxetine; Venlafaxine
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: The concurrent administration of tramadol and a selective serotonin reuptake inhibitor or the serotonin/norepinephrine reuptake inhibitors duloxetine or venlafaxine may result in additive blockade of serotonin reuptake, resulting in central serotonergic hyperstimulation. The combination may also lower the seizure threshold.The selective serotonin reuptake inhibitors and duloxetine may inhibit the metabolism of tramadol at CYP P-450-2D6, which may decrease its effectiveness by decreasing its transformation to its active metabolite.
CLINICAL EFFECTS: The concurrent administration may result in serotonin syndrome. Symptoms of serotonin syndrome may include irritability, altered consciousness, double vision, nausea, confusion, anxiety, hyperthermia, increased muscle tone, rigidity, myoclonus, rapid fluctuations in vital signs, and coma. Serotonin syndrome may result in death. Concurrent administration may also increase the risk of seizures and decrease the effectiveness of tramadol.
PREDISPOSING FACTORS: Predisposing factors include a history of seizures or epilepsy, a recognized risk for seizures (head trauma, metabolic disorders, alcohol, drug withdrawal, or infections of the central nervous system), or a genetic defect in CYP P-450-2D6.
PATIENT MANAGEMENT: If concurrent therapy is warranted, patients should be closely monitored for signs and symptoms of serotonin syndrome, seizure activity, and decreased tramadol effectiveness. Tramadol may need to be discontinued.The manufacturer of duloxetine states that concurrent use of tramadol is not recommended.(1)
DISCUSSION: There are several case reports of serotonin syndrome occurring following the addition of tramadol to a stable selective serotonin reuptake inhibitor regimen. The syndrome developed between 12 hours to 3 weeks after the initiation of tramadol therapy. The patients recovered after tramadol was discontinued.(2-12) One patient also developed mania.(2) Another patient developed nightmares and hallucinations after taking concurrent tramadol and paroxetine for 56 days.(13)A review of the 124 reports of seizures following tramadol therapy received by the FDA through July 31, 1996 revealed that 20 patients were receiving concurrent therapy with an selective serotonin reuptake inhibitor. (14)
The manufacturer of tramadol states that the risk of seizure is increased in patients receiving concurrent therapy with selective serotonin reuptake inhibitors.(15)
In a study in 16 healthy subjects, paroxetine (20 mg daily) decreased the formation of tramadol's active metabolite and tramadol effectiveness.(16)
There is one case report of serotonin syndrome with concurrent tramadol and venlafaxine.(17)
REFERENCES:1.Personal communication: Cymbalta (duloxetine HCl) concomitant opoid analgesic use. Eli Lilly and Company June, 2006.
2.Gonzalez-Pinto A, Imaz H, De Heredia JL, Gutierrez M, Mico JA. Mania and tramadol-fluoxetine combination. Am J Psychiatry 2001 Jun;158(6):964-5.
3.Mahlberg R, Kunz D, Sasse J, Kirchheiner J. Serotonin syndrome with tramadol and citalopram. Am J Psychiatry 2004 Jun;161(6):1129.
4.Mittino D, Mula M, Monaco F. Serotonin syndrome associated with tramadol-sertraline coadministration. Clin Neuropharmacol 2004 May-Jun; 27(3):150-1.
5.Mason BJ, Blackburn KH. Possible serotonin syndrome associated with tramadol and sertraline coadministration. Ann Pharmacother 1997 Feb; 31(2):175-7.
6.Sauget D, Franco PS, Amaniou M, Mazere J, Dantoine T. Possible serotonergic syndrome caused by combination of tramadol and sertraline in an elderly woman. Therapie 2002 May-Jun;57(3):309-10.
7.Lange-Asschenfeldt C, Weigmann H, Hiemke C, Mann K. Serotonin syndrome as a result of fluoxetine in a patient with tramadol abuse: plasma level-correlated symptomatology. J Clin Psychopharmacol 2002 Aug; 22(4):440-1.
8.Kesavan S, Sobala GM. Serotonin syndrome with fluoxetine plus tramadol. J R Soc Med 1999 Sep;92(9):474-5.
9.Egberts AC, ter Borgh J, Brodie-Meijer CC. Serotonin syndrome attributed to tramadol addition to paroxetine therapy. Int Clin Psychopharmacol 1997 May;12(3):181-2.
10.Lantz MS, Buchalter EN, Giambanco V. Serotonin syndrome following the administration of tramadol with paroxetine. Int J Geriatr Psychiatry 1998 May;13(5):343-5.
11.John AP, Koloth R. Severe serotonin toxicity and manic switch induced by combined use of tramadol and paroxetine. Aust N Z J Psychiatry 2007 Feb; 41(2):192-3.
12.Llinares-Tello F, Escriva-Moscardo S, Martinez-Pastor F, Martinez-Mascaraque P. Possible serotoninergic syndrome associated with coadministration of paroxetine and tramadol. Med Clin (Barc) 2007 Mar 24; 128(11):438.
13.Devulder J, De Laat M, Dumoulin K, Renson A, Rolly G. Nightmares and hallucinations after long-term intake of tramadol combined with antidepressants. Acta Clin Belg 1996;51(3):184-6.
14.Kahn LH, Alderfer RJ, Graham DJ. Seizures reported with tramadol. JAMA 1997 Nov 26;278(20):1661.
15.Ultram (tramadol) US prescribing information. Ortho-McNeil Pharmaceutical, Inc. September, 2006.
16.Laugesen S, Enggaard TP, Pedersen RS, Sindrup SH, Brosen K. Paroxetine, a cytochrome P450 2D6 inhibitor, diminishes the stereoselective O-demethylation and reduces the hypoalgesic effect of tramadol. Clin Pharmacol Ther 2005 Apr;77(4):312-23.
17.Venlafaxine + tramadol: serotonin syndrome. Prescrire Int 2004 Apr; 13(70):57.
poster:Phillipa
thread:907706
URL: http://www.dr-bob.org/babble/20090721/msgs/907746.html