Is Tramadol the Only Opioid Analgesic That Interacts?
Meperidine has long been known to have serotonergic effects and has produced severe serotonin syndrome when combined with drugs such as nonselective monoamine oxidase inhibitors (eg, tranylcypromine). Cases of serotonin syndrome have been reported when meperidine was combined with SSRIs. Fentanyl also has serotonergic effects and, like meperidine, has been associated with serotonin syndrome when combined with SSRIs. Morphine does not appear to have serotonergic effects and may be safer when combined with serotonergic drugs. Conclusion Concurrent administration of tramadol (and probably meperidine or fentanyl) with SSRIs or SNRIs appears to increase the risk of serotonin syndrome. In people who may require larger doses of tramadol, it would be prudent to avoid the combinations. If the combination is used, patients should be advised to watch for the telltale signs of serotonin syndrome, such as muscle jerking, muscle rigidity, and tremors, especially if accompanied by other symptoms, suc
