Drug Interactions Newsletter

Volume 1, Issue 9, 03/17/2009

Question

Part 1: How does the opioid analgesic tramadol (Ultram®; Ultram ER®, Ultracet®) increase the risk for developing serotonin syndrome in patients taking SSRI antidepressant medications?

Answer

This is part 1 of a 2 part series.  Chronic pain syndromes are common in patients with depression and have been associated with an increase in morbidity and mortality.(1,2)   Clinicians are increasingly placed in scenarios in which they must simultaneously treat both of these conditions.  Tramadol (Ultram®; Ultram ER®; Ultracet®) is a weak mu-opioid analgesic indicated for the treatment of moderate to moderately severe chronic pain and has also been recommended by some for pain patients with underlying depressive symptoms.(3)  Tramadol may be useful in patients with underlying depressive symptoms because it is also an inhibitor of the reuptake of the noradrenergic neurotransmitters norepinephrine and serotonin.(3)  Tramadol's effects on these neurotransmitters are dose dependent and have been shown to increase the risk of seizures and serotonin syndrome.(3,4)......To read the full answer please LOGIN or SUBSCRIBE NOW.