Tramadol – interaction with SSRIs and with Morphine

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Drugs associated with SerotoninToxicity• SSRIs - fluoxetine, fluvoxamine, paroxetine,citalopram, sertraline, escitalopram• SNRIs - venlafaxine, duloxitine, milnacipran,sibutramine• TCAs - clomipramine, imipramine• Opioids - pethidine, fentanyl, methadone,dextromethorphan, dextropropoxyphene, tramadol• Anti-histamines - chlorpheniramine, brompheniramine• Serotonin releasers - fenfluramine, amphetamine,MDMA (ectasy)• Monoamine oxidase inhibitors – moclobemide(reversible), linzolid; tranylcypromine, phenelzine• Others - lithium, tryptophan
Pathways by which serotonin acts within the centralnervous system (MJA 2007;187:361-5)
Page 2 and 3: Serotonin Syndrome (SS)• all drug
Page 4 and 5: Neuromuscular hyperactivityClonus,m
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 and 16: TramadolCYP2D6(sparteineoxidase)250
Page 17 and 18: TramadolMorphine• Does combinatio
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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