Increased risk of serotonin syndrome, do people consider it as a major interaction and one which needs tramadol replaced with a pain killer or you ok at low doses. I just don't see the point of risking the syndrome
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Increased risk of serotonin syndrome, do people consider it as a major interaction and one which needs tramadol replaced with a pain killer or you ok at low doses. I just don't see the point of risking the syndrome
Keep it surreal
Interaction more likely (and important) with drugs like fluoxetine and paroxetine which are more potent at inhibiting CYP2D6, which metabolises tramadol. However you need to put this in the context of widespread use of both of these types of drugs together. Increased serotonergic effects are probaby likely but serotonin syndrome is difficult to diagnose accurately anyway. And patients will often need appropriate analgesia - those that don't respond to or tolerate codeine well may be given tramadol as an alternative. Don't forget the additional risk of bleeding with using SSRI's and NSAID's together...
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Its a black dot interaction with ALL ssris though nik which is what concerns me. If you don;t respond to codeine next step up in pain ladder no? tramadol is same group of drugs as codeiene if im correct
Keep it surreal
Do not use the BNF alone in identifying drug interactions - very vague and often does not provide useful advice on managing potential interactions. Start getting into the habit of using Stockley's. There should be a copy at your hospital or community branch to refer to. If a pt is still in pain despite maximum tolerated codeine or other weak opioid then yes you would step up the pain ladder. Occasionally though some patients may benefit from switching for example if they are poor metabolisers of codeine. Anyway, regarding the interaction it would probably be something to keep an eye on if it was say paroxetine or fluox. Most patients can take this combo together and be OK.
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SPCs state don't use the two together so using them together is off license.
November 2010 SPC for sandoz generic
Citalopram 10mg Tablets - Summary of Product Characteristics (SPC) - electronic Medicines Compendium (eMC)Citalopram should not be used concomitantly with medicinal products with serotonergic effects such as sumatriptan or other triptans, tramadol, oxitriptan and tryptophan.
Cipramil SPC says the same
Cipramil Tablets - Summary of Product Characteristics (SPC) - electronic Medicines Compendium (eMC)Citalopram should not be used concomitantly with medicinal products with serotonergic effects such as sumatriptan or other triptans, tramadol, oxitriptan and tryptophan.
And in case you haven't seen this - New maximum daily dose for Citalopram and avoid drugs that prolong QT interval.
http://www.mhra.gov.uk/home/groups/d.../con137782.pdf
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Thought so web ferret, same goes with fluoxetine and other ssris I think...
what do you think now nik
King Amongst Members
The September 2011 SPC fro Prozac states:Originally Posted by Pharmguru
Note "use with care" rather than the "avoid" above.Serotonergic drugs: Co-administration with serotonergic drugs (e.g., tramadol, triptans) may increase the risk of serotonin syndrome. Use with triptans carries the additional risk of coronary vasoconstriction and hypertension.
Keep it surreal
SPC's are always going to be restrictive. I'm sure there are many other drug combinations which are similarly frowned upon but are used together in the vast majority of patients with no ill-effect. As mentioned, Stockley's is the best resource available for drug interactions and advice.
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