Effexor XR and Ultram

How risky is it to take Effexor XR and Ultram together?  My pharmacist alerted me to the fact that it was risky.  I have just been diagnosed with Multi Level Degenerative Disc Hypertrophy and am having a difficult time with managing my pain, but don't want to take the Ultram if it's dangerous.  What would you recommend for treating pain while taking Effexor XR?

Thanks so much.

[nick30]

No one here is in a position to tell you what to take, that is a decision that is always up to you along with your pharmacist and your Dr.
I would suggest returning to your Dr and telling him that your Pharmacist had concerns about those two drugs being taken together.
Perhaps your Dr will find an alternate medication for you.
There is an ' ask a pharmacist' section on this website, you could go there and ask, but in all honesty, you would be best going back to your own dr/pharmacist.
Wish you well,

Nick.

[Tuckamore]

I understand your concern. I would never combine medications after a pharmacist warned me of a risk. As I have said repeatedly on this forum, pharmacists are the real experts in medications. They spend years studying their actions, interactions, chemical components and so forth.

Physicians rely on the pharmacist in many situations. In my opinion you should return to your physician with the information from your pharmacist. He/she may change the meds or make the determination that you should consider the risk. It's my bet your physician will heed the pharmacist's concern. But I am not an expert and this will be totally up to your physician.

Please let us know how you are doing. Take care and be safe, Tuck

[jbtfuller]

Thank you for your comments!  Honestly, I didn't want someone to tell me what to take.  I just wondered if anyone had personal experiences with an alternative pain medication while taking Effexor.  

[toolmaker]

Please tell what kind of risk was mentioned.I have been taking these 2 meds together for almost 3 years.

[jbtfuller]

GENERALLY AVOID: Due to its serotonergic activity, coadministration of tramadol with serotonin-enhancing drugs such as SSRIs, SNRIs, nefazodone, trazodone, and mirtazapine may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Patients receiving tramadol with serotonin-enhancing drugs may also have an increased risk of seizures due to additive epileptogenic effects of these agents.

[sandee1818]

Tramadol will cause seizures in high amounts and when you add a drug that will add to the effects of the tramadol like Effexor XR does then your adding the risk of getting seizures. I have had a seizures from the tramadol and I fell and busted my head open prertty good and was in the hospitial for three days so please be very careful.
Go back to your doctor and get him to give you a different pain medication. Better safe than sorry. I was lucky I was just in line at burger king and not driving as I was a few minutes before the seizure.

[jbtfuller]

sandee, thank you for your sharing your personal experience with me.  I called the doctor and my nurse was off.  They told me to have the pharmacy fax their concerns to his office.  I still haven't hear from them, but do anticipate a call from my nurse this morning.  I will keep everyone posted.

[nick30]

I have also taken a trip to the ER to get my head stitched up thanks to tramadol. Although I only stayed 1 night.
I was making pizza for dinner then i woke up staring at the ceiling. I don't know how but i managed to need to be stitched up in 2 separate places.
pretty serious side effects for some people.

Nick

[GuitarNGamerGirl]

It's ****. It's not risky at all, I used to do it ALL the time. For a whole year, I took high levels of both drugs.

Mainly it's used as an excuse not to dispense Ultram, which isn't listed as a schedule drug but is treated by the AMA and those who monitor the Dr's prescribing practices as though it were. Some, not all, but some nurse practitioners and so forth love to deny painkillers to chronic pain patients, using effexor/ultram synergy as an excuse or to diagnose "signs of addctive behavior". If they do so, they have done SOMETHING, and it makes them feel powerful, like a doctor, in a world where really they are nothing more than a mechanical prescription-writer for a doctor so he can see more patients and charge insurance more money, without really seeing the patieint.

It's screwed UP!!!
Courtney Patricia "GuitarNGamerGirl" Parsons

[VaBreeze]

Interactions between your selected drugs
Effexor (venlafaxine) and Ultram (traMADOL) (Major Drug-Drug)

GENERALLY AVOID: Due to its serotonergic activity, coadministration of tramadol with serotonin-enhancing drugs such as SSRIs, SNRIs, nefazodone, trazodone, and mirtazapine may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Patients receiving tramadol with serotonin-enhancing drugs may also have an increased risk of seizures due to additive epileptogenic effects of these agents.

MANAGEMENT: In general, the use of tramadol in combination with highly serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life.

http://www.drugs.com/drug_interactions.php

There is absolutely a reason for concern in mixing these two medications.  I was on Ultram and had Effexor added later.  It provoked seizure activity.  Please be safe.

[VaBreeze]

oops.  I see someone else had already posted this same info.  Sorry for the duplicate, but it's worth saying twice.  :-)

Take care of you!

[jbtfuller]

I talked to the nurse at my dr.'s office and he still gave me the okay to take it.  My sister in law is an ER nurse and talked to some of the ER docs there and they said it is very rare for seizures/seratonin syndrome to occur.  But, still...I can't help but worry.

[VaBreeze]

My doctor also gave me the ok.  It was the pharmacist who inquired about whether or not I knew it could have an adverse reaction.  I had taken the Ultram with Cymbalta and it did fine...I felt the Effexor would be no different.  

You should know within an hour of taking them whether or not you can tolerate it.  Some people handle medications better than others.  If you feel that you need it for the pain, it would be good to have someone else with you during the first day of using it.  This way, if there is any type of reaction you won't be alone.  If it doesn't do well with you, you can discontinue one of them or have your doc. change it to something less likely to cause a bad incident.  You may do fine, but you won't know until you actually try it.  I hope you do well, but wanted to insure that you were aware of what could happen.  That's a risk with any type of medication...potential bad side-effects.

Best wishes.

[nick30]

It might be a good idea to get a second opinion, perhaps from another pharmacist as well as another dr. good luck, i hope it doesn't cause you the troubles it caused me.

Nick.

[BOK2Bjan]

I was going to give you the reason for the Pharmacist's warning, but as I kept reading the posts, I see you've been given more than enough information.  I'll just add my own experience.  I have taken Effexor ER for years now, as my SSRI of choice.  I also took it with Ultram.  The pharmacist is obligated to print out an interaction sheet any time a RX is given that has the potential for interaction.  And it should be paid attention to.  But, it is rare, and yet that's no reason to be over confident you'll be fine.  I'd suggest you have your serotonin levels checked - not a guarantee of the brain level, but a good ball park - and if your levels are high or borderline high - stay off the ultram.  But if your levels are low or low normal etc., then (WITH DR's approval), I wouldn't hesitate to go ahead.  I had no problem, but have low serotonin.  The other issue is what dose the Ultram is.  That makes a huge difference, as well as the Effexor dose.  37.5, 75, or 150?  And is the Ultram XR, or regular.  If you're uncomfortable, your doctor could also check once a month - on your levels.  They're both good drugs, so I hope you can get good guidance from your physician and pharmacist.  Take care

Blessings, Jan

[big_papa37]

Hello iam new here I am taking tramadol 50 mgs,neurontin 300mg,hydrocodon-acetaminoph,a pain patch of 25mcg/hr and cymbalta 90 mg. And  my Dr. Wants me to take effexor xr 75mg in lu of cymbalta (the cymbalta was given to me by a shrink for pain control) but I am told that effexor xr n tramadol don't mix.

It all started when I had back surgury on my (L5-L4-S1) disces and still in a lot of pain

[big_papa37]

Hello iam new here I am taking tramadol 50 mgs,neurontin 300mg,hydrocodon-acetaminoph,a pain patch of 25mcg/hr and cymbalta 90 mg. And  my Dr. Wants me to take effexor xr 75mg in lu of cymbalta (the cymbalta was given to me by a shrink for pain control) but I am told that effexor xr n tramadol don't mix.

It all started when I had back surgury on my (L5-L4-S1) disces and still in a lot of pain

[marycarmel]

Just want to point out that this is a very old thread.  For the best results, post a new question and hopefully someone with more experience will answer.  There is often very good advice given here but you always need to check things with your own doctors and pharmacists.  You are on quite a lot of medications.  I'm curious as to how long this has been going on.  I was on even more than you are but I did not like the Fentanyl and I got tired of the doctors throwing new drugs at me all the time.  I was concerned that at 50 I was building a huge tolerance and was afraid if something came up down the road, they'd have a hard time managing my pain.  I am only pointing this out because there is something called hyperalgesia and it actually causes your pain to increase.  I found that I can usually manage without narcotics and they told me I'd never be able to.  There are times I take them as needed but I usually use other things like Advil, heat, lidoderm patches, Voltaren gel, etc.  It may be something you'd like to consider to find where your real pain levels are.  Of course, you would want to talk to your doctor if you plan on tapering down.  

[tt444]

I am a 2 time breast cancer pt. with mastectomy (left side total and right side normal)  I am also left handed so I irritate myself daily.  I was on a narcotic and wanted to change to Tramadol. So Im on tramadol now.  But, Im also taking-Effexor,neurotin,Soma,Seroquel xr.  Why did my Dr. prescribe Tramadol with all that Im reading Im afraid.  Help.