Effexor & Tramadol (Ultram) have major drug interactions

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Drug 1: EFFEXOR 50MG TABLETS Drug 2: TRAMADOL 50MG TABLETS Type:

Drug/Drug Severity: MAJOR Description: EFFEXOR 50MG TABLETS with

TRAMADOL 50MG TABLETS

Onset: Delayed Severity: Major Documentation: Suspected

Increased risk of seizures is listed in the manufacturer's package labeling as a

possibility when TRAMADOL 50MG TABLETS and EFFEXOR 50MG TABLETS are

co-administered. Serotonin syndrome is also a risk with this combination.

Details: Effect: Increased risk of seizures is listed in the manufacturer's

package labeling as a possibility when TRAMADOL 50MG TABLETS and EFFEXOR 50MG

TABLETS are co-administered. Serotonin syndrome is also a risk with this

combination.

Mechanism: Unknown.

Management: Use of TRAMADOL 50MG TABLETS with EFFEXOR 50MG TABLETS is not

recommended.

Discussion: The following statement appears in the manufacturer's package

labeling: Administration of Ultram may enhance the seizure risk in patients

taking tricyclic antidepressants and other tricyclic compounds (eg,

cyclobenzaprine, promethazine, etc.), selective serotonin reuptake inhibitors

(SSRI antidepressants or anorectics), MAO inhibitors, neuroleptics, other drugs

that reduce the seizure threshold (1). No controlled literature is available to

describe the nature, precipitating conditions, mechanism, or possible outcome of

this potential interaction. The Netherlands Pharmacovigilance Foundation has

reported the case of a 47-year-old man who had been taking paroxetine 20 mg

daily for 4 months (2). Twelve hours after ingesting one dose of tramadol 100

mg, serotonin syndrome developed. He had used tramadol in the past without

incident. An additional case (3) describes a 72-year-old woman who was treated

for 10 years with fluoxetine. After 18 days of concomitant

tramadol for articular pain the patient began to feel nervous and developed

piloerection and muscular contractions. She stopped taking tramadol and the

physical symptoms disappeared by day 21. In an additional reported case (4),

serotonin syndrome occurred with high doses of both fluoxetine (80 mg/d) and

tramadol (800 mg/d). High cerebrospinal fluid concentrations of serotonin have

been proposed as a marker for serotonin syndrome, as they correlated with

symptoms and time course in a 75-year-old woman (6). A 70-year-old woman who was

receiving citalopram for mild recurrent depressive disorder for a period of more

than 3 years developed serotonin syndrome while receiving tramadol for

post-operative pain (5). Symptoms included tremors, restlessness, fever,

confusion, and visual hallucinations and were noted to begin 3 days after

starting tramadol. Tramadol was stopped and the patient's symptoms resolved. One

year later, while still receiving citalopram, she suffered similar

symptoms after starting tramadol. Serotonin syndrome has been reported in

patients receiving the combination of venlafaxine with tramadol (7-9). It should

be noted that in at least 2 of the cases, patients were receiving at least one

other drug for depression in addition to venlafaxine (7,8).

References: 1. Official package labeling for Ultram (tramadol). McNeil

Pharmaceuticals, Spring House, PA, (1996). 2. Egberts ACG et al: Int Clin

Psychopharmacol 12:181(1997). 3. -Pinto A et al: Am J Psychiatry

158:964(2001). 4. Lange-Asschenfeldt C et al: J Clin Psychopharmacol

22:440(2002). 5. Mahlberg R et al: Am J Psychiatry 161:1129(2004). 6. Mittino D

et al: Clin Neuropharmacol 27:150(2004). 7. Ripple MG et al: Am J Forensic Med

Pathol 21:370(2000). 8. Houlihan DJ: Ann Pharmacother 38:411(2004). 9. Anon:

Prescrire Int 13:57(2004).

Nancie Taube wrote: If you read that tramodol and

effexor don't go together, please don't take them. I have tried both...effexor

for depression, tramadol as an alternative to vicodin, not at the same time, I

can't take either. Effexor knocked me off my feet, literally, I took 4 doses

over the course of 3 days, and fell flat and couldn't get up or walk. Ended up

in the hospital. Tramadol just plain makes me sick...so sick I can't take it.

I've been on Vicodin for years, I have a dr. I haven't seen in over a year, he

does my refills for me, 100 at a time. I love him for that. I don't get addicted

to it, I get sick if I take more than 1 1/2 a day, but at least I know I have

them, and they work a bit for me.

I wouldn't take the tramadol if I were you...stick with the vicodin if your dr.

will fill the scrip. In my case it hasn't been addictive...of course everyone is

different.

nancie

wahtrends wrote:

My doctor prescribed me 300mg of Effexor per day, and I was on

Vicodin twice a day for several months. He started complaining I was

going to get 'hooked' on the Vicodin so he didn't want me to refill

it anymore. The OTC pain meds just don't do the job for me, and most

of the non-narcotic prescription pain meds don't work either. I had

heard about Ultram or Tramadol being a good alternative to Vicodin so

I asked him about that one. He okayed it for a trial at 50mg per day,

and continuing on my same Effexor dose. I also take 10mg of Ambien at

night.

My question is about the combination of the Effexor and Tramadol.

After I got the prescription filled for the Tramadol, I started

feeling kind of dizzy and weird. I looked it up online to see if that

was a normal side effect, and I found a ton of places where it said

Effexor and Tramadol are not to be taken together because it can

cause severe problems including death! Now I'm just terrified and

wondering if I should even continue taking the Tramadol. I can't

figure out why I would be prescribed this combination if it is

potentially fatal? I don't know if my feeling dizzy is normal for

the first time taking Tramadol, or if I should be concerned. I'm so

confused.

Thanks,

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