Tramadol Clomipramine

If patient Is taking any agent that can Inhibit serotonin reuptake (e.g., SSRIs, sibutramlne, tramadol, mllnacipran, duloxetine, venlafaxine, clomipramine, etc.)... 

Since the monoamine effects of tramadol resemble the effect of antidepressants, it has been compared with clomipramine + levomepromazine in patients with postherpetic neuralgia. The incidence of adverse effects was 77% with tramadol and 83% with clomipramine (SEDA-20, 81). 

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... 

In general, the concurrent use of most opioids and tricyclics is uneventful, although lethargy, sedation, and respiratory depression have been reported. Tramadol should be used with caution with tricyclic antidepressants because of the possible risk of seizures and the serotonin syndrome. Dextroproposyphene may cause moderate rises in the serum levels of amitriptyline and nortriptyUne, and methadone may moderately raise desipramine levels. The bioavailability and the degree of analgesia of oral morphine is increased by clomipramine, desipramine and possibly amitriptyline. 

The serotonin syndrome developed in one patient on iproniazid and tramadol, and delirium in another given tramadol shortly after stopping phenelzine. A fatal case of possible serotonin syndrome has been seen with tramadol, moclobemide and clomipramine. 

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. ... 

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