Posted by Sunnely on September 10, 2000, at 20:48:10
In reply to Can I take ultram with prozac, posted by Dona on September 10, 2000, at 11:31:06
> I take 40mg of prozac a day for depression. I recently had knee replacement surgery ( what a hard job that was!) and am tired of heavy narcotics for pain. Does anyone know if it is safe to take ultram? The literature says an increased seizure risk, but how often is this true? Thanks
Hi Dona,
Indeed, the risk of seizures increases with the combined use of Ultram (tramadol) and antidepressants. I don't know the exact rate of occurrence, but I supposed it is related to the amount (dose), "pharmacokinetic" and other factors, and individual differences.
"Serotonin syndrome" is also a potential drug-drug interaction between Ultram and an SSRI (e.g., Prozac, Zoloft, Paxil, Luvox, Celexa), or the other serotonin-boosting antidepressants. Serotonin syndrome may include the following symptoms acute confusion, agitation, shivering, teeth-chattering, muscle rigidity, tremor, profuse sweating, rapid heart rate, rapid respiration, myoclonic jerks (muscle twitchings, jerking), and even seizures. Deaths from serotonin syndrome have been reported.
Ultram is a non-narcotic analgesic (pain killer). As an analgesic, it acts by binding to u-opiate receptors in the brain, altering the perception of and response to pain. In addition, it also inhibits the reuptake of serotonin and norepinephrine, which also modifies the pain pathway. Its reuptake inhibition of serotonin (and norepinephrine) may contribute to the increased risk of serotonin syndrome, if combined with the SSRIs.
Based on "pharmacokinetic" factors, theoretically, the likelihood of serotonin syndrome with the combination of Prozac and Ultram seems greater. FYI, Ultram is metabolized (broken down) by the liver enzyme called CYP2D6; Prozac is a potent inhibitor of the action of this liver enzyme. The combination of these drugs would lead to a decrease in the metabolism of Ultram, leading to an increase in its blood level, leading to an increase in serotonin effect, and eventually, serotonin syndrome.
Finally, Ultram, with its reuptake inhibition of serotonin and norepinephrine, may lead to increased risk of mania, especially in patients with bipolar disorder.
BTW, using a "pain killer" with codeine component along with Prozac may prove ineffective. Codeine is a "pro-drug," i.e., it has to be converted into an active compound (morphine) to be an effective "pain killer." To do so, it needs the intervention of the liver enzyme CYP2D6. Prozac, being a potent inhibitor of the action of this enzyme, prevents the conversion of codeine to morphine, hence, analgesic effect is not attained.
Just my own 2-cents.
References:
1. Mason BJ, Blackburn KH: Possible serotonin syndrome associated with tramadol and sertraline coadministration. Ann Pharmacotherapy 1997;31:175-177.
2. Watts B, Grady T: Tramadol-induced mania (letter). American Journal of Psychiatry 1997;154(November):1624.
3. Metabolic Drug Interactions 2000, Levy RH, Thummel KE, Trager WF, Hansten PD, Eichelbaum M (editors) Lippincott, Williams & Wilkins, Philadelphia.
poster:Sunnely
thread:44539
URL: http://www.dr-bob.org/babble/20000905/msgs/44579.html