Posted by Jedi on March 16, 2007, at 2:23:17
In reply to When all else fails, try Ultram, posted by UGottaHaveHope on March 15, 2007, at 22:11:23
Tramadol is a mildly serotonergic opiod that can cause serotonin syndrome when taken with a MAOI. Similar to meperidine in this regard, it can even cause DEATH!!! Think outside the box but do all your research. Taking MAOIs adds another level of responsibility to the patient. Many of the long term MAOI patients on this board know more than most PDOCs and MDs about these medications. You have to take the responsibility yourself. I know this is very difficult when you are deathly ill. I've been there.
Jedi (See abstract below)> For all the hopeless out there, please read this post a few weeks ago from Blueberry. It's one of the greatest ever on this board. Think outside the box, folks!
>
> + + + + + + + + + + + + +
> FROM BLUEBERRY1
> > To answer your questions and share my thoughts with all here...
> >
> > Tramadol is about 75% relief of depression, fear, and anxiety parts of the day, and 100% relief at random times of the day. Anxiety...
__________________________________________________________________Full text: http://bja.oxfordjournals.org/cgi/content/full/95/4/434
Br J Anaesth. 2005 Oct;95(4):434-41. Epub 2005 Jul 28.
Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity.Gillman PK.
Pioneer Valley Private Hospital, Mackay, Queensland, Australia. [email protected]Toxicity resulting from excessive intra-synaptic serotonin, historically referred to as serotonin syndrome, is now understood to be an intra-synaptic serotonin concentration-related phenomenon. Recent research more clearly delineates serotonin toxicity as a discreet toxidrome characterized by clonus, hyper-reflexia, hyperthermia and agitation. Serotonergic side-effects occur with serotonergic drugs, and overdoses of serotonin re-uptake inhibitors (SRIs) frequently produce marked serotonergic side-effects, and in 15% of cases, moderate serotonergic toxicity, but not to a severe degree, which produces hyperthermia and risk of death. It is only combinations of serotonergic drugs acting by different mechanisms that are capable of raising intra-synaptic serotonin to a level that is life threatening. The combination that most commonly does this is a monoamine oxidase inhibitor (MAOI) drug combined with any SRI. There are a number of lesser-known drugs that are MAOIs, such as linezolid and moclobemide; and some opioid analgesics have serotonergic activity. These properties when combined can precipitate life threatening serotonin toxicity. Possibly preventable deaths are still occurring. Knowledge of the properties of these drugs will therefore help to ensure that problems can be avoided in most clinical situations, and treated appropriately (with 5-HT(2A) antagonists for severe cases) if they occur. The phenylpiperidine series opioids, pethidine (meperidine), tramadol, methadone and dextromethorphan and propoxyphene, appear to be weak serotonin re-uptake inhibitors and have all been involved in serotonin toxicity reactions with MAOIs (including some fatalities). Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity with MAOIs.
PMID: 16051647 [PubMed - indexed for MEDLINE]
poster:Jedi
thread:741443
URL: http://www.dr-bob.org/babble/20070314/msgs/741513.html