Tramadol Mirtazapine

Fenfluramine Dextromethorphan Meperidine Methylene dioxymethamphetamine Meta-chlorophenylpiperazine (mCPP) Trazodone (mCPP) Selegiline Nefazodone Trazodone Pethidine Tramadol Mirtazapine TCA medications Venlafaxine SSRI agents... 

A 47-year-old man with a long history of depression had been stable on a combination of venlafaxine 300 mg/day and mirtazapine 30 mg/day for 3 months. He started to take tramadol for a chronic pain syndrome and the dose was titrated up to 300 mg/day over the next 4 weeks. The dose was then increased to 400 mg/day, and 8 days later he developed shivering, sweating, myoclonus, hyper-reflexia, and mydriasis. His medications were withdrawn, but over the next 4 hours he developed a fever (39.2°C) and a tachycardia. He was given intravenous hydration and closely monitored, and the symptoms resolved over the next 36 hours. Venlafaxine and mirtazapine were restarted and he remained symptom free. 

Houlihan DJ. Serotonin syndrome resulting from coadministration of tramadol, venlafaxine and mirtazapine. Ann Pharmacother 2004 38 411-3. 

Similarly, seizures and the serotonin syndrome have been reported in a woman who took mirtazapine with tramadol, but this may have been due to over-use of the tramadol rather than an interaction. Lethargy, confusion, hypotension, bronchospasm and hypoxia has also been seen following the use of tramadol and mirtazapine, which resolved within hours of both drugs being stopped. ... 

Houlihan DJ. SerotCTiin syndrane resulting frcm coadministration of tramadol, venlafaxine, and mirtazapine. ArmPharmacodter(2O0A) 38,411-13. 

Two cases of the serotonin syndrome have been reported when tramadol was given with venlafaxine one patient was also receiving mirtazapine. Fatal seizures occurred in an alcoholic man receiving tramadol, venlafaxine, quetiapine and trazodone. 

Nervous system There have been two reports of movement disorders induced by mirtazapine. Most of a case series of 14 patients with restless legs syndrome presented within a few days of starting treatment, and the symptom occurred more often in those who also took tramadol or dopamine receptor antagonists, such as antiemetics [72 ]. In one case, severe akathisia developed within 4 hours of a first... 

Figure 2 Selective mass chromatograms indicating atypical antidepressants in an urine extract after acid hydrolysis and acetylation. Peak 1 indicates mirtazapine, peak 2 the bis-demethyl metabolite of the opioid tramadol, peak 3 the hydroxy metabolite of mirtazapine, and peak 4 the nor metabolite of mirtazapine.

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