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Does Sertraline Interact With Tramadol?
Question: Hi, my cousin has a question. He is 33 years old and is very obese. He has issues with his knee and sees a rheumatologist. He is currently taking mirtazapine, diazepam and tramadol. The tramadol is for his knee and back pain. His rheumatologist suggested to his GP to change from mirtazapine to another antidepressant as mirtazapine causes weight gain. The GP changed him to sertraline but when he saw the pharmacist they raised the issue of an interaction with sertraline and tramadol - serotonin syndrome. After the pharmacist contacted the GP she said to not change. After a week or so the GP changed his mirtazapine to duloxetine. He had a reaction to duloxetine and the GP says she doesn't want to try anything else and to stick to mirtazapine and monitor his weight. We are concerned as he is already very obese. Just wanted an opinion on whether the interaction between other antidepressants and tramadol is significant enough for him not to try them at all? He takes 200mg tramadol twice daily (the slow release ones). Sometimes he needs only once daily. What is your opinion on this because we just feel the GP seems a little bit not very familiar with these medications.
Brief Answer:
There are other options
Detailed Answer:
Hello,
Thanks for using healthcaremagic.
I read your query and understand your concerns.
First regarding serotonin syndrome it is really a big complication of certain drugs and should be avoided as long as possible. SSRI (sertraline) and tramadol have association with serotonin syndrome and not recommended for use together.
There is one molecule called bupropion which can be safely used in your cousin. It does not have any interaction with current medications and weight neutral. The other option is Tianeptine and can be considered if available in your country (Not available in USA).
In addition to this if no suitable antidepressant found for him, a change in pain killer can be considered. Except tramadol no pain killer is associated with serotonin syndrome and can be used safely. This includes Nsaids, Oxycodone, propoxyvon etc.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
There are other options
Detailed Answer:
Hello,
Thanks for using healthcaremagic.
I read your query and understand your concerns.
First regarding serotonin syndrome it is really a big complication of certain drugs and should be avoided as long as possible. SSRI (sertraline) and tramadol have association with serotonin syndrome and not recommended for use together.
There is one molecule called bupropion which can be safely used in your cousin. It does not have any interaction with current medications and weight neutral. The other option is Tianeptine and can be considered if available in your country (Not available in USA).
In addition to this if no suitable antidepressant found for him, a change in pain killer can be considered. Except tramadol no pain killer is associated with serotonin syndrome and can be used safely. This includes Nsaids, Oxycodone, propoxyvon etc.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer
I will suggest to him to enquire with his GP about your two suggestions. I don't think they are available as the GP said there were no other options, but will definitely check.
You don't think using sertraline is recommended? I heard some people use it with tramadol and have no reaction?
Also, the GP doesn't want to try any opioids because of risk of getting addicted and also he is very young and wants to reserve that. He does take NSAIDs sometimes but finds it doesn't work well for him. Tramadol works very well but unfortunately for this problem.
In your opinion, would you say its ok to continue taking mirtazapine and tramadol as long as he keeps an eye on his weight as the GP has suggested?
I will suggest to him to enquire with his GP about your two suggestions. I don't think they are available as the GP said there were no other options, but will definitely check.
You don't think using sertraline is recommended? I heard some people use it with tramadol and have no reaction?
Also, the GP doesn't want to try any opioids because of risk of getting addicted and also he is very young and wants to reserve that. He does take NSAIDs sometimes but finds it doesn't work well for him. Tramadol works very well but unfortunately for this problem.
In your opinion, would you say its ok to continue taking mirtazapine and tramadol as long as he keeps an eye on his weight as the GP has suggested?
Brief Answer:
yes it can be used but close monitoring required
Detailed Answer:
Hello,
Thanks for reverting back to me.
Bupropion is available in most of the countries and I hope same applies to your country.
Regarding combination yes they can be used but close monitoring will be required. I do not recommend for outpatient basis treatment with sertraline and tramadol together.
I hope this clarifies.
Thanks and regards
yes it can be used but close monitoring required
Detailed Answer:
Hello,
Thanks for reverting back to me.
Bupropion is available in most of the countries and I hope same applies to your country.
Regarding combination yes they can be used but close monitoring will be required. I do not recommend for outpatient basis treatment with sertraline and tramadol together.
I hope this clarifies.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again
When you say you do not recommend outpatient basis treatment, do you mean if patient is only seeing a GP once every few months or so then that is not enough monitoring?
If sertraline and tramadol were used together and if there was a reaction of serotonin syndrome, would that take just a few weeks to come up and if no reaction in few weeks then that means there wont be any reaction at those dosages? Or can the reaction occur randomly?
If he were to stay on mirtazaine, is the weight gain with mirtazapine definite? do all people on it get it and is it going to affect him?
Also, I will definitely check regarding the buproprion. We are in Australia. Would it work as well as mirtazapine?
Just if the buproprion does not work or there are some problems with it, would you prefer for your patients to continue on mirtazapine and tramadol or to risk trying sertraline or something else similar with tramadol? Knowing that he is very obese already?
The GP is not happy to change the tramadol for the reasons I gave above, because he is young and she doesn't want him to start on any opioids yet. Do you think that is best or would you say opioids are ok at this stage?
When you say you do not recommend outpatient basis treatment, do you mean if patient is only seeing a GP once every few months or so then that is not enough monitoring?
If sertraline and tramadol were used together and if there was a reaction of serotonin syndrome, would that take just a few weeks to come up and if no reaction in few weeks then that means there wont be any reaction at those dosages? Or can the reaction occur randomly?
If he were to stay on mirtazaine, is the weight gain with mirtazapine definite? do all people on it get it and is it going to affect him?
Also, I will definitely check regarding the buproprion. We are in Australia. Would it work as well as mirtazapine?
Just if the buproprion does not work or there are some problems with it, would you prefer for your patients to continue on mirtazapine and tramadol or to risk trying sertraline or something else similar with tramadol? Knowing that he is very obese already?
The GP is not happy to change the tramadol for the reasons I gave above, because he is young and she doesn't want him to start on any opioids yet. Do you think that is best or would you say opioids are ok at this stage?
Brief Answer:
Close monitoring mean seeing a doctor at least once a week to every day
Detailed Answer:
Hello,
Thanks for follow up.
Close monitoring is not possible when someone sees a doctor at a gap of weeks.
Yes mirtazapine can be continued if he takes necessary action to check over weight with help of exercise and sticking to low calorie diets. I guess he have some limitations for exercise which may compromise his exercise capacity. Issue of weight gain is not universal but it is common with Mirtazapine. More than half of those on mirtazapine gain significant weight.
Bupropion is available In Australia.
Regarding serotonin syndrome it is a dose dependent reaction and generally occurs in first two weeks of start/dose change. Chances of random reaction are almost nil.
Regarding his GPs reluctance I want to make it clear that tramadol is opioid derivative and not much different from other opioids.
I hope this helps you.
Thanks and regards
Close monitoring mean seeing a doctor at least once a week to every day
Detailed Answer:
Hello,
Thanks for follow up.
Close monitoring is not possible when someone sees a doctor at a gap of weeks.
Yes mirtazapine can be continued if he takes necessary action to check over weight with help of exercise and sticking to low calorie diets. I guess he have some limitations for exercise which may compromise his exercise capacity. Issue of weight gain is not universal but it is common with Mirtazapine. More than half of those on mirtazapine gain significant weight.
Bupropion is available In Australia.
Regarding serotonin syndrome it is a dose dependent reaction and generally occurs in first two weeks of start/dose change. Chances of random reaction are almost nil.
Regarding his GPs reluctance I want to make it clear that tramadol is opioid derivative and not much different from other opioids.
I hope this helps you.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again .. just a quick follow-up question, if the serotonin syndrome reaction occurs in the first few weeks, then the close monitoring is only for the first couple of weeks and if no reaction then it can be assumed that it is safe to be taken together?
If there is weight gain on mirtazapine despite exercise and diet, is it safe to continue? Is there any medicine that can help him loose weight?
If there is weight gain on mirtazapine despite exercise and diet, is it safe to continue? Is there any medicine that can help him loose weight?
Brief Answer:
Best medicine for weight loss is exercise and diet management
Detailed Answer:
Hello,
Thanks again for follow up.
The chances become low with time but a good understaning of serotonin syndrome required with reporting to doctor in case there is anything suggestive of it happens. It can not be guaranteed with confidence.
Best medication for weight management is exercise and diet management. In case that does not work next is changing medication. Third line is giving another medication like metformin, topiramate etc. Medicines are least preferred for weight loss as risk benefit ratio is generally against medication in regard to weight management.
I believe this answers your question.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Best medicine for weight loss is exercise and diet management
Detailed Answer:
Hello,
Thanks again for follow up.
The chances become low with time but a good understaning of serotonin syndrome required with reporting to doctor in case there is anything suggestive of it happens. It can not be guaranteed with confidence.
Best medication for weight management is exercise and diet management. In case that does not work next is changing medication. Third line is giving another medication like metformin, topiramate etc. Medicines are least preferred for weight loss as risk benefit ratio is generally against medication in regard to weight management.
I believe this answers your question.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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