Venlafaxine tramadol

The death of a 36-year-old patient with a history of alcohol dependence who was taking tramadol, venlafaxine, trazodone, and quetiapine has highlighted the increased risk of seizures with concomitant use of tramadol and selective serotonin re-uptake inhibitors (125). 

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

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. 

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

Allen KR (2006) Interference by venlafaxine ingestion in the detection of tramadol by liquid chromatography linked to tandem mass spectrometry for the screening of illicit drugs in human urine. Clin Toxicol 44 147-153... 

The analgesic drug tramadol can cause 5HT toxicity in association with SSRIs. Venlafaxine is also a potent reuptake inhibitor, and perhaps not surprisingly has been reported to cause features of the 5HT syndrome in a patient taking tramadol (49). 

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 His medications were withdrawn, but over the next 4 hours he developed a fever (39.2°C) and a tachycardia.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. 

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

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... 

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