drug interaction

An elderly gentleman is prescribed Ultram 50mg q 6 hr prn
plus  Celexa was 40 mg. qd. What are the possible interactions and are there  any contraindications for use in this circumstance?
TX
albert600

[Alison L, RPh]

Ultram (Tramadol) is an opioid pain medication and Celexa (Citalopram) is a Selective Serotonin Reuptake Inhibitor (SSRI) used for many different conditions such as depression, anxiety, and other mood disorders. There is a risk/interaction when taking these two medications together, but it is not an absolute contraindication for their use in a patient,but should be avoided if possible.  A possible side effect of Ultram (Tramadol) is an increased risk for seizures, even when taken within the recommended dosage (max of 400mg in a 24 hour period), and is increased in patients taking medications like Celexa (Citalopram). Also, a patient is at increased risk for a condition known as serotonin syndrome. Certain medications, illicit drugs, and dietary supplements can cause serotonin syndrome and it usually occurs within several hours of starting a new medication or increasing a dose of a medication you are currently taking. Signs and symptoms include agitation, confusion, rapid heart rate, dilated pupils, muscle twitching, sweating or shivering, diarrhea, and headache. Severe symptoms can be life threatening and one should seek immediate medical attention if they experience high fevers, seizures, irregular heart beat or unconsciousness. I would recommend having a discussion with your doctor about the two medications and see if one (the easiest would be the pain medication) can be changed to avoid this possible interaction.