Tramadol fluoxetine

Varian (see Catalog, SPE products) Focus Polar functionalized styrene-divinylbenzene polymer Reversed phase with strong hydrogen bond donor, acceptor, and dipolar character Fluoxetine, verapamil, olanzapine, tramadol, loratidine, and sumatriptane (81) verdanafil (82)... 

Betamethasone + Gentamicin S-Amlodipine + Losartan S-Amlodipine + Atenolol Pioglitazone + Glimeperide Glimeperide + Metformin Rosiglitazone + Glimeperide Tramadol + Paracetamol Ramipril + s(-) Amlodipine Olanzapine + Fluoxetine Ciprofloxacin + Ornidazole Quinapril + HCTZ (Hydrochlorothiazide)... 

Fluoxetine and paroxetine inhibit cytochrome CYP P-450 2D6 and thus may affect metabolism of some opioids, e.g. codeine, 0) codone and tramadol, that are partly metabolised by CYP2D6, many antipsychotic drugs and tricyclic antidepressants. 

Serotonin syndrome and mania occurred in a 72-year-old woman taking fluoxetine 20 mg/day and tramadol 150 mg/day 18 days after she started to take the combination (122). Inhibition of CYP2D6 may have played a part (123). 

Gonzalez-Pinto A, Imaz H, De Heredia JL, Gutierrez M, Mico JA. Mania and tramadol-fluoxetine combination. Am J Psychiatry 2001 158(6) 964-5. 

SSRIs OPIOIDS 1. Possible 1 analgesic effect of oxycodone and tramadol 2. T serotonin effects, including possible cases of serotonin syndrome, when opioids (oxycodone, pethidine, pentazocine, tramadol) are co-administered with SSRIs (fluoxetine and sertraline) 3. SSRIs may t codeine, fentanyl, methadone, pethidine and tramadol levels 1. Uncertain. Paroxetine inhibits CYP2D6, which is required to produce the active form of tramadol. 2. Uncertain 3. SSRIs inhibit CYP2D6-mediated metabolism of these opioids 1. Consider using an alternative opioid 2. Look for signs of T serotonin activity, particularly on initiating therapy 3. Watch for excessive narcotization... 

Tramadol increases the risk of seizures in patients taking TCAs Use of TCAs/tetracyclics with anticholinergic drugs may result in paralytic ileus or hyperthermia Fluoxetine, paroxetine, bupropion, duloxetine, and other CYP450 2D6 inhibitors may increase TCA/tetracyclic concentrations... 

Timolol Desip ra mine Fluoxetine Fluvoxamine Imipramine Mianserin Nortriptyline Paroxetine Risperidone Thioridazine Zuclopenthixol Perhexiline Propafenone Sparteine Dextromethorphan Phenformin Tramadol... 

Tramadol Five reports describe the development of the serotonin syndrome in patients on fluoxetine, paroxetine, or sertraline when tramadol was added. Another patient developed hallucinations with tramadol and paroxetine. Other reports suggest that the SSRI/tramadol combination is therapeutically valuable and normally safe. Also, carefully monitor concomitant use with fluvoxamine. 

Clinically important, potentially hazardous interactions with amitriptyline, amoxapine, amphetamines, bupropion, citalopram, clomipramine, cyproheptadine, desipramine, dextroamphetamine, dextromethorphan, diethylpropion, dopamine, doxepin, entacapone, ephedra, ephedrine, epinephrine, fluoxetine, fluvoxamine, ginseng, imipramine, levodopa, mazindol, meperidine, methamphetamine, nefazodone, nortriptyline, paroxetine, phendimetrazine, phentermine, phenylephrine, pizotifen, propoxyphene, protriptyline, pseudoephedrine, rizatriptan, sertraline, sibutramine, sumatriptan, sympathomimetics, tramadol, tricyclic antidepressants, trimipramine, tryptophan, venlafaxine, zolmitriptan... 

Ajmaline, alprenolol, amiflamine, amphetamine, aprindine, captopril, chlorpheniramine, cinnarizine, citalopram, clomipramine, clozapine, codeine, desipramine, dolasteron, encainide, flecainide, fluoxetine, fluphenazine, haloperidol, hydrocordone, imipramine, loratidine, methoxyphenamine, 3,4-methylenedioxymethamphetamine, metoprolol, mexiletine, (S)- and (i )-mianserin, nifedipine, olanzapine, omeprazole, oxycodone, perhexiline, phenformin, propaphenone, propranolol, remoxipride, ritonavir, saquinavir, selegiline, tamsulosin, timolol, tomoxetine, tramadol, trifluperidol, zolpidem... 

A small study in healthy subjects found no problems when moclobemide was given 24 hours after clomipramine. However, the serotonin syndrome occurred in 3 patients when clomipramine was replaced by mo-clobemide without a washout period or with only a 24-hour washout period, " and in another patient when moclobemide was replaced by clomipramine after only 12 hours. A fatal case of the serotonin syndrome occurred in a patient taking clomipramine and amitriptyline, with symptoms manifesting within 30 minutes of a 300-mg dose of moclobemide. Two other patients developed fatal serotonin syndrome after taking moderate overdoses of moclobemide and clomipramine. The serotonin syndrome has been reported in at least 8 other cases of moclobemide and clomipramine overdose, one of which also involved tramadol (see also MAOIs + Opioids Tramadol, p.ll41), another fluoxetine (see also MAOIs or RIMAs + SSRIs, p.l 142), and yet another buspirone (see also MAOIs or RIMAs + Buspirone, p.l 133). Conversely, a case of an overdose of moclobemide and clomipramine resulted in no adverse effects except sinus tachycardia. ... 

Tramadol analgesia may possibly be altered by paroxetine and potentially by other drugs that inhibit CYP2D6, such as fluoxetine. ... 

Kesavan S, Sobala GM. Serotonin s3nidrome widi fluoxetine plus tramadol. JR Soc Med (1999) 92,474-5. 

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