Tramadol sertraline

The serotonin syndrome has been reported after concurrent use of tramadol and sertraline (SEDA-22,103). 

Serotonin syndrome occurred in an 88-year-old woman who took sertraline 50-100 mg/day and tramadol 200-400 mg/day for 10 days the symptoms subsided 15 days after withdrawal of tramadol (124). 

Sauget D, Franco PS, Amaniou M, Mazere J, Dantoine T. Possible syndrome serotoninergiques induit par [ association de tramadol a de la sertraline chez une femme agee. [Possible serotonergic syndrome caused by combination of tramadol and sertraline in an elderly woman.] Therapie. 57(3) 309-10. 

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 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... 

Serotonin syndrome has been reported when tramadol was combined with sertraline. 

An 88-year-old woman taking sertraline 50 mg daily (later increased to 100 mg daily), as well as several other medications was given dextropro-poxyphene with paracetamol and tramadol 200 mg daily increased to 400 mg daily for pain relief after a fracture. Ten days after starting tramadol she became confused, with alterations in cognitive function, tremor, problems with co-ordination and muscle weakness. The serotonin syndrome was suspected and therefore sertraline was withdrawn over a period of 2 days, the dose of tramadol was reduced from 400 to 200 mg daily, and the patient recovered over a period of about 2 weeks. ... 

In another report, the serotonin syndrome occurred after the first dose of sertraline 50 mg in a 75-year-old woman who had been taking tramadol 50 mg daily for 3 days. The concentration of serotonin (5-hydroxytryp-tamine) in her CSF was found to be elevated to 38.5 nanograms/mL (normal value less than 10 picograms/mL)."... 

Mason BJ, Blackburn KH. Possible serotonin s3nidrome associated with tramadol and sertraline coadministration. yfwwP/rawracoifrer (199 31, 175-7. 

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