Combinations - SSRI Interactions with Tramadol

[kritikal]

I recently started Aropax (Brand name for Paroxetine in Aus) at 20mg a day in the morning.

Since then i have managed to get Henoch-Shonlein Purpura which is an infection that causes inflammation of the capilleries and causes petatchie (minor internal bleeding) I was in hospital for a few days with IV antibiotics but have since been released with a bundle of Antibiotics and a Script of Panadeine Forte (500mg APAP 30mg Codeine) My Med ran out and so i went to see the doctor about something possibly stronger due to the fact that Forte was not relieving my pain. He gave me Tramadol and suggested to take 100mg four times daily.

Now i know that Tramadol can inhibit the reuptake of serotonin as well as my med can, so there is some possibility of Serotonin Syndrome. Although the doctor suggested that it would be highly doubtful with the amounts of both medications.

So i am curious as to whether or not it would be safe to take this medication? How about higher doses? I am told to take 8 in a day and Tramadols effects last about 8 hours so i would always have around 200mg in my body. So say if were to take 4-5 (200mg-250mg) at once and no more for that day would it be considered to be no more different than having the normal dosage.

Reputation Comments on this post:

Self-Incrimination.

[Forthesevenlakes]

heres my advice: do not, under any circumstances, combine tramadol and an SSRI. tramadol is more potent is an SSRI than one might immediately think, just reflect upon the fact that one of its withdrawal symptoms is depression (and one thats very unlike an opiate withdrawal depression). SWIY definitely runs the risk of serotonin syndrome or all manners of nasty derealization, emotional effects, or worse yet, seizures even with small "abusable" amounts of tramadol. SWIMs advice is that, to some extent, codeine-containing products can be found OTC where you life, do some research and seek those out instead if you're looking for something to enjoy. just avoid those trams...too risky!

[kritikal]

Exactly how i felt i said too the doctor r u sure? He said it would be fine but i realy do not feel safe with it at all.

I have used codeine many times and partly why i went to the doctors, was to see them bcoz i ran out of codeine and it wasnt doin enuf.

I might try make an appointment and try and get something else coz it is my life that the doctors are risking.

sorry bout the short typin i'm just drunk and hell lzy!

[Nagognog2]

Abusing medication is against the law in Australia. Nice of you to incriminate yourself. Other than that, tramadol is, indeed, an SSRI on it's own merit. Mixing this with paroxetine is begging for trouble by really throwing off your serotonin levels. I'd say your doctor doesn't know what he's talking about. And many do not as more and more, generally nasty, information is becoming available about these drugs every day. Usually as a result of some poor slob (that would be you) ending up in serious medical trouble due to having been prescribed one of these. Try reading this thread and you'll see what I mean:

http://www.drugs-forum.com/forum/showthread.php?t=14891

Also, increased dosages of tramadol usually don't feel pleasant like standard opiates. They can cause extreme sweating, vertigo, vomiting, headache - to name a few side effects. And that's without mixing them with anything. Tramadol is another new drug that begs for further research. I'll bet it will end up being withdrawn from the market due to toxicity in a few years' time.

[kritikal]

Yes i have read that thread before and it certainly did scare me.

I am not going to touch this crap as i dont want to die.

The only reason for abuse is to relieve the pain.

[JewishNazi]

I would go back to the doctors but this time see a different one. 100mgs of tramadol can be enough for someone without a tolerance to get a nice opiate high. However, I asume that SWIY does have a tolerance and would need in the range of 300 - 500.

It seems strange that he would perscribe such high doses

[kritikal]

he has prescribed me for 50-100mg four times a day as needed. To be honest this has done nothing for me at all. If anything the pains are worse.

I had 50mg with 60mg codeine and felt a weird high that felt different to just opiates. Somehow i managed to get some THC into my system though. It gave me extreme anxiety.

I really just want something to get rid of this pain so i can get on with my life

[kritikal]

Well after the pain got much worse this morning and My foot had swollen everywhere, i decided to goto the hospital.

They didnt believe that he had given me Tramadol with me being on Paroxetine and advised me to immediately not take it anymore.

So instead i got a Nice prescription for Oxycodone instead.

[DrMuffy]

SWIdr has recently been on a tramadol binge, he will take up to 900mgs a day. SWIdr used to be on prozac (30 mgs a day) and recently quit a month or so before his binge. SWIdr knows tramadol does have weak activity on the Seritonin receptor, but at doses like 900 mgs, it can be a big SSRI. SWIdr has recently been depressed and wants to switch to an SSRI (preferably before or while his is quiting tramadol). Does anyone have any experience and or knowledge on interaction between starting an SSRI and tramadol or which medication works best for this situation. SWIdr's psyciatrist (sp?) is ready to prescribe almost anything so any advice is welcome!

[Micklemouse]

2 words - Serotonin Syndrome. Mixing 2 serotonergic agents is a potentially fatal idea, & is something that will have a pharmacist with any knowledge slapping his forehead with his hand repeatedly (A Certain Mouse has seen this with his own eyes on more than one occasion, often with the very combintion SWiDr is proposing!)

Also, 900 mgs is an immense dose - the maximum recommended dose for pain relief is 400 mgs in 24 hours, 600 mg for post-operative pain (BNF 53).

[DrMuffy]

Originally Posted by Micklemouse

2 words - Serotonin Syndrome. Mixing 2 serotonergic agents is a potentially fatal idea, & is something that will have a pharmacist with any knowledge slapping his forehead with his hand repeatedly (A Certain Mouse has seen this with his own eyes on more than one occasion, often with the very combintion SWiDr is proposing!)

Also, 900 mgs is an immense dose - the maximum recommended dose for pain relief is 400 mgs in 24 hours, 600 mg for post-operative pain (BNF 53).

Thank you SWImickle, so should SWIdr ween himself off trmadol, and then wait till it is out of his system and then start an SSRI? Yes 900mgs is a very dangerous dose, which will cause seizures to occure much more often. SWIdr usually potentiate his tramadole with several substances and uses a lesser dose (200 mgs-400 mgs), so he does keep the higher dose danger in mind. But SWIdr admits he has stupidly used up to 900 mgs of tramadol to obtain desired effects (very stupid) and was lucky he never had a seizure. Again SWIdr thanks you, SWImickle, for his concern/advice, and appreciates it very much!

[Micklemouse]

S'alright mate! Yes, weaning off the Tramodol is highly recommended before starting an SSRI antidepressant. Sources differ on the halflife of Tramodol, so working out the length of time needed is difficult - I can't find any recommendations for SSRI's but 14 days is stated for starting MAOI's after tramodol, so this should be the least SWiY should wait. At least one of it's metabolites is pharmocologically active (O-desmethyltramadol), but this appears to be more on the opioid receptor side than the serotonin. Bear in mind that there have been cases of serotonin syndrome with other synthetic opioids too, most notably pethedine & dxm, but also oxycodone if I remember correctly (check the Search Engine - I've posted on this I'm sure!).

http://www.medsafe.govt.nz/profs/Dat...Tramedocap.htm

[DrMuffy]

Thank you again, yes SWIdr has experienced the dreadful Serotonin SYdrome when he used DXM while on Prozac (He was yound and didn't know much). Its funny that SWIY mentions O-desmethyltramadol because SWIdr just wrote a paper containing it in the opiates forum!

[Lehendakari]

Originally Posted by DrMuffy

SWIdr has recently been on a tramadol binge, he will take up to 900mgs a day. SWIdr used to be on prozac (30 mgs a day) and recently quit a month or so before his binge. SWIdr knows tramadol does have weak activity on the Seritonin receptor, but at doses like 900 mgs, it can be a big SSRI. SWIdr has recently been depressed and wants to switch to an SSRI (preferably before or while his is quiting tramadol). Does anyone have any experience and or knowledge on interaction between starting an SSRI and tramadol or which medication works best for this situation. SWIdr's psyciatrist (sp?) is ready to prescribe almost anything so any advice is welcome!

He is deppressed even taking that amount of tramadol?? If he got depressed while having serotonin re-uptake inhibited, don't you think tramadol has something to do with it?

I'm just guessing, but perhaps the whole tramadol binging thing is causing him to be depressed, and there is really no need to take prozac.

SWIM was on paxil a while ago and although it was good for him he thinks tramadol is better, and much faster acting.

[DrMuffy]

Originally Posted by Lehendakari

He is deppressed even taking that amount of tramadol?? If he got depressed while having serotonin re-uptake inhibited, don't you think tramadol has something to do with it?

I'm just guessing, but perhaps the whole tramadol binging thing is causing him to be depressed, and there is really no need to take prozac.

SWIM was on paxil a while ago and although it was good for him he thinks tramadol is better, and much faster acting.

Sorry, SWIdr didn't specify, he was already feeling depressed before he started his escapades with tramadol. SWIdr had convo with his psyciatrist and has a plan to ween himself off of his daily dosage of tramadol (now 400-600 mgs a day). He will take one half pill less per day and work his way SLOWELY off it. SWIdr's psyc said the exact same as SWIbejeda (Thanks Bejeda!), so as soon as tramadol is totally off of his sysem he will start an SSRI (which one he does not know, but they have seemed to help in the past). By the way, does anyone know the fastest acting (Serotonin reuptake) inhibitor is?

[DrMuffy]

SWIdr has been thinking lately and finds that it is mentally impossible to ween himself off tramadol, due to the temptation that he could just take more and get higher. The half-life of tramadol is 6-9 hours, which is really short. SWIdr actually thinks he will continue till he is out of tramadols and quit cold turkey, and start taking a small amount of suboxone (hopefully if the doc prescribes it), kratom, or loperamide and start an SNRI like effexor 12 hours after the last dosage. Does anyone think this might cause big problems (besides WD symtoms) since tramadol works on norepinephrine and serotonin also?

[Paracelsus]

In that case, it would be better for SWIdr to quit the tramadol NOW and drug the toilet with it. Don't "plan" an addiction ffs!

If SWIdr is 100% sure he can control himself and live with the tramadol in the house without touching it (many think so), OK. Otherwise, the toilet's waiting.

[DrMuffy]

Originally Posted by Paracelsus

In that case, it would be better for SWIdr to quit the tramadol NOW and drug the toilet with it. Don't "plan" an addiction ffs!

If SWIdr is 100% sure he can control himself and live with the tramadol in the house without touching it (many think so), OK. Otherwise, the toilet's waiting.

Very true but the periphial toilet is coming soon anyways since SWIdr now has a little more than #100 50mg pills left, and he hate would hate to see them go to waste ...

[DrMuffy]

Once again, SWIdr would like to thank those who have given advice on this topic! He could have done alot more damage without some of this information... SWIdr is seeing a psyciatrist now, so hopefully, he will be of some assistance to this problem (Prescriptions, advice, information, etc). Oh, one last question, could a small dose of suboxone help SWIdr when it comes to his WDs.

Note:His daily dose of Tramadol is roughly 800 mgs (on average).

[RonArtest]

So, SWIM is looking for a low grade opiate for daily pain and management for his irritable bowel syndrome. Hes taking 20mg of lexapro a day, and wants to try something else along that line, but also needs a low grade opiate. perhaps the SSRI thing could come up with the doctor, and he could switch to tramadol and kill 2 birds with one stone? or it doesnt work that way?

Sorry for the ignorance.

[someone111]

so SWIM takes up to 10 tramadols at once to get a weak buzz. there 50 mg. wat drug should SWIM switch to, to get a full out high agin thats like tramadol.

[Paracelsus]

The only advantage of tramadol is that it's unscheduled. Most other opiates are safer and 'better' than tramadol, especially if one has an opiate tolerance.

[toe]

Almost anything other than proproxyphene. Even without an SSRI, tramadol 400mg/day is the upper limit before lowering the seizure threshold.

[GrailKing]

I take tramadol and effexor daily. Effexor is an snri and they are quite a successful combination for the treatment of major depression and analgesia.
I would say from experience that tramal is also advantagous because;'
1. it doesnt have the WD's that other narcotics have.
2. tolerance to therapuetic doses isnt much of an issue..again no where close to the opiod narcots.
3. And!...the big one..less addictive! U want hide stashes around the house in case u run out.