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Tramadol - Interactions and Warnings

There is evidence of other less well known and potentially clinically significant drug-drug interactions, including the ability of selective serotonin reuptake inhibitors to inhibit the analgesic activity of tramadol and codeine through inhibition of their metabolic activation, to induce serotonin syndrome when used chronically in the presence of high doses of tramadol through synergistic serotonergic action, and to increase the potential for gastrointestinal bleeding associated with NSAID therapy through additive or supra-additive antiplatelet activity.
- Clin Ther. 2007;29 Suppl:2477-97. Adverse drug interactions involving common prescription and over-the-counter analgesic agents.Hersh EV, Pinto A, Moore PA.

The threshold for seizures is lowered by tramadol. In addition, the risk for seizure is enhanced by the concomitant use of tramadol with selective serotonin reuptake inhibitors or neuroleptics, and its use in patients with a recognized risk for seizures, i.e., alcohol withdrawal. This case appears to be the first reported death caused by seizure activity in a patient taking tramadol in combination with drugs that affect serotonin.
- Am J Forensic Med Pathol 2000 Dec;21(4):370-4 -- Lethal combination of tramadol and multiple drugs affecting serotonin. -- Ripple MG, Pestaner JP, Levine BS, Smialek JE.

Report of a possible case of serotonin syndrome associated with coadministration of tramadol hydrochloride and sertraline hydrochloride.
- Ann Pharmacother 1997 Feb;31(2):175-7 -- Possible serotonin syndrome associated with tramadol and sertraline coadministration. -- Mason BJ, Blackburn KH.

Consult with your physician before using herbs and supplements especially ones that may have an effect on mood or the brain such as St. John's Wort.

last update: November 2008

This information is not intended to be a substitute for professional medical advice. You should not use this material to diagnose or treat a health condition or disease without consulting with your healthcare provider.
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