Posted by jedi on May 27, 2010, at 23:58:51
In reply to at it again: tramadol xr, posted by floatingbridge on May 27, 2010, at 2:24:25
FB,
I would not risk taking tramadol with almost any of the ADs. Like meperidine it is one of the opioids that affects serotonin. When combining medications that affect serotonin in different ways your risk of serotonin syndrome is just too high. You do not want this affliction, it can lead to the long dirt nap.
Be careful,
JediReference:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714818/?tool=pubmed
Tramadol
Seizures, Serotonin Syndrome, and Coadministered Antidepressants
...
Serotonin syndrome (SS). SS is a potentially lethal event that is caused by excessive serotonergic agonism of serotonin receptors in the central and peripheral nervous system. SS may develop as a result of increased serotonin synthesis, decreased serotonin metabolism, increased serotonin release, inhibition of serotonin reuptake (e.g., SSRIs), and/or direct agonism of serotonin receptors. The syndrome is most often the result of a prescription drug, overdose of causative drugs, and/or complex interactions among several drugs. Three key clinical features of this syndrome are as follows: (1) neuromuscular hyperactivity (e.g., tremor, clonus, myoclonus, hyperreflexia, rigidity); (2) autonomic hyperactivity (e.g., diaphoresis, fever, tachycardia, tachypnea); and (3) altered mental status (e.g., agitation, confusion).23 There is no designated laboratory study for the diagnosis of SS.24 Management consists of discontinuing the offending agent and providing supportive care. Signs and symptoms typically resolve within 24 hours after the discontinuation of the causative medication, except in patients exposed to drugs with long elimination half-lives.25 Serotonin antagonists, such as cyproheptadine, may help alleviate symptoms, although the efficacy of this pharmacological intervention has not been rigorously studied.25
Tramadol as a factor. Like the risk of seizures, SS may occur with tramadol monotherapy but appears to be more common following either excessive use/overdose or with the coadministration of other medications, particularly antidepressants. With regard to the antidepressant interactions, SS has been reported with combinations of tramadol and the following: fluoxetine,2628 sertraline,2931 paroxetine,3235 citalopram,36 fluvoxamine,37 venlafaxine,38,39 and TCAs.40 In addition, Gnanadesigan et al41 reported four cases of SS among residents in a long-term care facility, all who were prescribed tramadol in combination with either SSRIs or mirtazapine. The majority of these preceding case reports describe elderly individuals who were oftentimes prescribed other medications as well.
Jedi
Treatment resistant, atypical, double depression with social anxiety.
Nardil + clonazepam
poster:jedi
thread:949074
URL: http://www.dr-bob.org/babble/20100524/msgs/949199.html