Aa
Aa
A
A
A
Close
Avatar universal

Drug interaction / seratonin syndrome

I was recently put on tramadol 300mg in divided doses, 2 days ago. I took the first dose 2 days ago(100mg) and yesterday I took 2 doses, 1 am and second in the PM. I felt extremely agitated, nervous, crying over nothing, a little sweaty but not bad. I don't know if seratonin syndrome can come on that quickly or if I was experiencing increased anxiety because I know about the syndrome. So many people say NEVER take tramadol and Zoloft together and that they have ended up in the hospital after only taking 200 mg of tramadol while currently taking 100mg or less of Zoloft or another SSRI. Am I just being paranoid? I don't want to chance this syndrome. Please help me......I was never told of safe doses just told by doc if I had any of the symptoms get to the ER ASAP. Why take the chance? That is my feeling.
3 Responses
Sort by: Helpful Oldest Newest
Avatar universal
Oh, Carrie, I do not take the clonidine any longer but have been on Robaxin, Zoloft, & lyrica for years. I get no sleepiness, etc from any of these together or alone. ( just an FYI )
Helpful - 0
Avatar universal
Thanks for your response. I quit the tramadol immediately after having a reaction of confusion and feeling off. I do feel much better, thank you. I will be bringing this up to my physician at my next appointment in a couple weeks. He did, however, explain this to me that an interaction could occu & to seek medical attention immediately. However, and I am extremely upset about this, the pharmacist never mentioned a word and I have been using the same pharm for years. I'm sorry, but as far as I am concerned, the info given with your meds is not enough.....most people don't read that info since they "trust" their doctors completely. I'm sure you know what I mean.

Anyway, thank you....I did not seek medical attention as the S&S just appeared and was not grave. I knew to stop the medication and stopping just the tramadol would be enough at that time. However, had the symptoms persisted after stopping that med then I would have gone to the hospital as I know Zoloft & tramadol, in this case, should have both been stopped.
Helpful - 0
5801192 tn?1389200487
MEDICAL PROFESSIONAL
Dear NurseTracy:

I apologize for the delayed response. I hope you are feeling better since your last post. It sounded concerning, and I hope your condition had improved.

You are correct about there the MAJOR drug interaction between tramadol and sertraline (Zoloft). Please note that there are several moderate drug interactions with your medications, for example, sertraline (Zoloft), pregabalin (Lyrica), clonidine, and methocarbamol (Robaxin) all can increase side effects such dizziness, drowsiness, and impaired thinking and judgment when taken together. It would be a good idea to review your medication regimen with your provider and pharmacist.

From the package insert of tramadol, under serotonin syndrome risk:
************************************************************************************
"The development of a potentially life-threatening serotonin syndrome may occur with the use of tramadol products, including tramadol hydrochloride, particularly with concomitant use of serotonergic drugs such as SSRIs, SNRIs, TCAs, MAOIs, and triptans, with drugs which impair metabolism of serotonin (including MAOIs), and with drugs which impair metabolism of tramadol (CYP2D6 and CYP3A4 inhibitors). This may occur within the recommended dose (see CLINICAL PHARMACOLOGY, Pharmacokinetics ).

Serotonin syndrome may include mental-status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).
************************************************************************************
If you are still symptomatic, please seek medical assistance right away. Serotonin syndrome may be life threatening. You know your body best. So, if you are not feeling well, you need to speak up and seek support.

Good luck and take care!

For more information, please go to:
1. Serotonin Syndrome - Medline Plus
http://www.nlm.nih.gov/medlineplus/ency/article/007272.htm

Tramadol - Daily Med
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=052d06ef-4186-4ac1-9099-af05fa37c2f8#warnings_serotonin

2. Sertraline - Daily Med
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=a8b2ad71-cfdc-4a29-8194-deefea138b16
Helpful - 0

You are reading content posted in the Ask a Pharmacist Forum

Popular Resources
Discharge often isn't normal, and could mean an infection or an STD.
In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die.
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
When it comes to your health, timing is everything
We’ve got a crash course on metabolism basics.
Learn what you can do to avoid ski injury and other common winter sports injury.