Tramadol – interaction with SSRIs and with Morphine

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TramadolMorphineTramadolEnantiomer - weak mu opioideffectEnantiomer – inhibitsnoradrenaline/serotonin uptake+ activates descending monoaminergicinhibitory pathsMorphinemu opioid agonist - Activatesdescending analgesic pathsInhibits sub P release at spinalcord synapseHyperpolarises post-synapticinter-neuronesPotency (weight for weight)intravenous 1 10epidural 1 13
TramadolMorphine• Does combination increase efficacy with lessadverse effects?Yes!No!• Evidence from studies on post-operative pain fortramadol/morphine combination is mixed
Page 2 and 3: Serotonin Syndrome (SS)• all drug
Page 4 and 5: Neuromuscular hyperactivityClonus,m
Page 6 and 7: Drugs associated with SerotoninToxi
Page 8 and 9: Cyproheptadine (5-HT 2Aantag)to red
Page 10 and 11: Tramadol and SSRIs• Tramadol - at
Page 13 and 14: Tramadoland Morphine• Multimodal
Page 15: TramadolCYP2D6(sparteineoxidase)250
Page 19 and 20: Median (and interquartile range) of
Page 21 and 22: Pain Intensity in Three groups by N
Page 23 and 24: Median Effective Dose of Tramadol a
Page 25 and 26: Mean (95% CI) Values for analgesic
Page 27 and 28: Mean Post-operative Pain Scores (±

Tramadol – interaction with SSRIs and with Morphine

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