Tramadol Paroxetine

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. 

A 66-year-old tetraparetic man developed hallucinations while taking tramadol, paroxetine, and dosulepin for chronic pain (654). 

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... 

Laugesen S, Enggaard TP, Pedersen RS, et al. Paroxetine, a cytochrome P450 2D6 inhibitor, diminishes the stereoselective 0-demethylation and reduces the hypoalgesic effect of tramadol. Clin Pharmacol Ther 2005 77 312-323. 

A tetraparetic patient with chronic pain developed nightmares and hallucinations 56 days after starting to take tramadol, paroxetine and dosulepin, which only stopped when the drugs were withdrawn. ... 

A double-blind, placebo-controlled, crossover study in 16 healthy extensive metabolisers found that pretreatment with paroxetine 20 mg daily for 3 days increased the AUC of (+)- and (-)-tramadol by 37% and 32%, respectively and decreased the AUCs of the O-demethylated metabolites of tramadol by 67% and 40%, respectively. The analgesic effect of tramadol was reduced, but not abolished. ... 

Paroxetine is a potent inhibitor of the cytochrome P450 isoenzyme CYP2D6 and inhibits the CYP2D6 mediated formation of the O-demeth-ylated metabolites of tramadol. The reduction in these metabolites may result in reduced analgesia as the opioid effect of tramadol is thought to be mediated mainly by (+)-0-desmethyltramadol. ... 

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

Egberts ACG, ter Borgh J, Brodie-Meijer CCE. Serotonin S57ndrome attributed to tramadol addition to paroxetine therapy.(1997) 12,181-182. 

Lantz MS, Buchalter EN, Giambanco V. Serotonin syndrome following the administration of tramadol with paroxetine. IntJ GeriatrPsychiatry (1998) 13, 343-5. 

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