The People's Perspective on Medicine

Tramadol Plus Sertraline Could be Deadly Cocktail

Tramadol has become a popular pain reliever, perhaps because of the opioid epidemic. Tramadol plus sertraline can pose a risk for serotonin syndrome.

Serotonin is a crucial neurotransmitter. It is found in the brain as well as the digestive tract. Serotonin is also found in blood cells called platelets. It plays a crucial role in regulating mood. That is why some of the most successful antidepressants are called SSRIs (selective serotonin reuptake inhibitors). Serotonin also impacts libido and sexual function as well as memory, digestion, sleep and blood clotting. When there is excessive serotonin circulating in the body it can lead to “serotonin syndrome.” The pain reliever Tramadol plus sertraline for depression could prove dangerous if not deadly.

A Close Call with Tramadol Plus Sertraline:

Q. I have been taking tramadol, amitriptyline and sertraline for more than three years. I was having a hard time with my depression and told my doc it was getting worse.

She increased the dose of sertraline from 100 mg to 150 mg. Five days later I had a seizure. Nobody could understand why.

My electrolytes were abnormal, so I went back to see the doctor a few weeks later and asked if the increased dosage could have been the cause.

She dismissed that idea, but since then I have seen two other doctors who both expressed concern about this combination of drugs. One of them said it could be a lethal cocktail, and the combination could well have caused my seizure. I feel as if I’ve been misled by someone I trusted. I’d be grateful for your opinion.

Tramadol Plus Sertraline and Amitriptyline Is Scary:

A. The pain reliever tramadol and the SSRI-type antidepressant sertraline could interact to trigger serotonin syndrome. Excessive levels of the neurochemical serotonin can lead to agitation, confusion, muscle twitches, tremor, sweating and seizures (Pharmacy Times, July 15, 2009).

Adding amitriptyline makes this combination even more hazardous. Electrolytes can also be disrupted.

Serotonin Syndrome Stories:

L.D.V.D. shared this experience from hell:

“I have been on tramadol for pain and Cymbalta (duloxetine) for depression. I got depressed due to the constant pain I was in-sciatic nerve pain.

“About 10 days ago I felt extremely sick. Got myself out of bed and off to a doctor. She immediately said that I have serotonin syndrome and must go to hospital emergency department. She called them.

“They ran drips into me which stopped the uncontrolled twitching. They informed me to stop taking tramadol and Cymbalta immediately. Well, that was like sending me straight to hell! I have been so ill the last 10 days. Today is the first morning I could get out of bed without first walking into something.

“My symptoms are as follows:

“Severe brain zaps. If I move my eyes, I get brain zaps. Had really bad flu-like symptoms. Hot flashes. I wake up every night and my pj’s are soaked through. My husband said he touched me one night as I was restless in my sleep. He said I was all wet.

“I have had diarrhea now for 6 days. Get very weird dreams. In the last 2 days I have felt depressed, crying my eyes out – the next minute I want to punch someone. Please tell me it will stop.”

Another reader offered a similar story:

“Recently my husband took tramadol after back surgery. He was also taking an SSRI anti-depressant.

“He suffered severe hallucinations and sleep-talking throughout the night. The ER doctor suspected serotonin toxicity from the combination of tramadol and the SSRI. It took almost a week for him to get back to normal without tramadol.”

Becky in Depew, New York shares a pharmacist’s perspective:

“Re: the writer who asked why she had a seizure after using an increased dose of SSRI and Tramadol: her pharmacist should also have counseled her about this possible reaction. Our pharmacists do it, but only if someone cares enough about their health to stick around and listen.

“We have a ‘counseling required’ note at the bottom of the receipt, but many people say, ‘I’ve been taking this for YEARS.’ And leave. One problem that might have been encountered is mail-order meds. Even though there’s the same notation on the receipt, most people do not call to find out what the issue is. They absolutely must.”

People’s Pharmacy Perspective:

We agree with Becky. We have watched way to many people grab and go in the pharmacy. They don’t even bother to check to make sure their prescription is correct. But serotonin syndrome can be caused by a great many drug combinations. Tramadol plus sertraline plus amitriptyline is a particularly dangerous interaction.

Learn more about serotonin syndrome and tramadol at this link:

“Tremors from Tramadol Could be Scary Serotonin Syndrome.”

Our book, Top Screwups, reveals much more about this condition and how it should be prevented. Here is a link so you can protect yourself and those you love.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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My husband was put on Tramadol in 2009 for back pain. One tablet every six hours. He also was on Xanax. His doctor said it was least addictive. I tried to get him to take it less often but he continued for five years. No doctor ever questioned if his pain had lessened. In 2014 I noticed he was not taking it as often. When his battery was replaced in the pacemaker his doctor gave him a Valium before the minor surgery. After that he began memory loss. He had several falls. I think the Tramadol caused dizziness. He is off all pain meds. He uses a Rollator.

He never complains of pain now. I do not know when he quit feeling pain in his back and seldom complains of pain anywhere. I think Tramadol killed his pain center and certainly contributed to his memory loss. Our pharmacist agrees with me that Tramadol is addictive. I think once a patient is given pain meds that the doctor should try to wean them from the pains.

Thank you for this article. I had a severe reaction. Several years ago I took Tramadol for neck pain as needed. I had developed GI issues with Motrin. I was also taking Trazadone for help with sleep. I threw my back out dancing at my nephew’s wedding and took tramadol. I also took Unasome to help with sleep after several hours. I awoke the next day with horrible tremors. By the time it was done i could hardly speak, walk or hold a cup. My chiropractor of many years thought I was having a stroke. I went to the ER they had no answers. I was admitted and a neurologist patted me on my hand recommending psychotherapy for my anxiety disorder. I took the medication for a few more days and thought I will throw all of this away since it started with the medication. I have never taken tramadol or trazadone again. Nor anymore parkinsonian tremors or speech.

What do you think about this cocktail, which nearly killed me, I reckon? It was prescribed by my Doctor in New Zealand. I wonder how the pharma companies get their so-called medicines past the regulators.

I was prescibed Effexor for migraine/anxiety in June 2016. 7months later I had my first noticeable seizure in a public situation, although in retrospect I believe I had other more minor-seeming absence-like seizures before that, as in “the lights are on but no one’s home.” Effexor put me in a new zone. My 7 year old granddaughter called me a zombie. Then my doc prescribed Topomax for the seizures, and it was a fast decline after that. Neither drug can be stopped suddenly, and my Doctor was removed from our medical center.

No-one at the medical center was prepared to commit to a plan for me to taper off these drugs, so public mental health was my only option after a referral. There I got an intake interview with an Occupational Therapist, delving into my history of trauma, which left me with an involuntary jolt which I have to this day, and no advice about meds. The point for her was to see if I was trying to get out of work from the benefits point of view, and she cannot advise about medications. She presented my case to the doctors involved at her organisation, and a month later I eventually got my appointment with someone who could advise me about tapering, which is where the fun really started.

What I don’t get is how the Pharma companies and Doctors prescribing the drugs get the sanction to provide such treatment in the name of care. Also that the short appointments one gets clearly cannot provide you with all the information you need to make an informed choice before starting these chemical cocktails. I did research the drugs before taking them, talking to pharmacists about drug interactions and was told nothing was available showing the interaction between the drugs in my combo.

If it wasn’t for my ashram buddies I’d be another statistic, road kill by now. I believe it is way too much responsibility to place on ordinary people to manage the tapering of these poisons in a residential setting with absolutely minimal support from the system
I am unable to drive, lost my loved employment, and am required to just pick up the pieces of my life at the age of 56. Am not feeling that hopeful either as I jolt my way through conversations that stress me let alone the prospect of an interview.
Tapering off these drugs was the hardest experience of my life, even with good support.

Well, you are at it again: the constant war on tramadol. Keep on: you will probably get it pulled from the market.
Your ads NEVER give the other side of the story.
How about something like: “just stop taking the sertraline, try another one.”

You all just can’t help yourselves: can you.

I am so thankful for the People’s Pharmacy. I have had back issues that have gotten worse with age, especially with the onset of arthritis of the spine. On the advice of my doctor I was consuming 2400 mg of ibuprofen daily.

I have been on a low dosage of sertraline for years and started taking tramadol several years ago at night. My ortho doctor put me on gabapentin and subsequently added methylprednisolone to alleviate the pain. Instead the pain increased.

I stopped taking the gabapentin and the prednisolone, and the tramadol. Recently, I purchased your book on arthritis and discovered how ibupropen atually increases the pain caused by arthritis and I stopped taking ibupropen.

Amazingly, not only has the pain drastically decreased so has my high blood pressure, which for the first time in years is normal. I now drink red grape juice mixed with Certo twice a day and the arthritic pain is negligible. I may take an aspirin once in a while. Thank you. Marge C. .

I wad prescribed Tramadol after surgery. Since I have bad reactions to Oxycodone and Hydrocodone, the doctor tried Tramadol. I also take anti-depressants. The first time I took it I had extreme agitation and legs twitching all night. I thought it was restless leg syndrome (which I had never had before). After some research I learned the problems with this drug combination. I quit immediately and switched to Tylenol and got along fine.

Why didn’t the problems with this combination show up when the physician prescribed Tramadol? I thought such was required before any prescription. Isn’t this why we have to make a list of every prescription drug every time we go to the doctor’s office?

Great that you are bringing this up.

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