# tramadol and pristiq together?



## Cydnie (Aug 30, 2010)

I am starting to wonder about my psych doc unfortunately. I was warned by my pharmacist not to take my pain med (ultram/tramadol) with pristiq because of serotonin syndrome. I double checked with another pharm, and again they told me that would be a problem, but the rest of my meds would be fine. My psych doc told me that my other meds like adderall, and inderal would be the problem and not the pristiq. I am beginning to wonder about his abilities unfortunately after he had me go up way too fast on requip when I asked if I could titrate slower, then got very sick, and then he told me to stop immediately (until the nausea went away) and I've been so sick ever since. But since he told me the pristiq and ultram are fine together and the two pharmacists disagree with him, has anyone heard that these are okay to take? I'm too nervous to take them, and feeling like my life's in my doc's hands, but am a little unsure. They are apparently similar in structure, and snris. Not sure what to do! Thanks!:|


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## rustybob (Nov 19, 2009)

Well tramadol is a seratonin releaser and NRI, not SNRI. I can't think of why they would be contraindicated. MDMA is a seratonin releaser, and when you take it on an SSRI it doesn't cause seratonin syndrome, it just does nothing. 

I don't know tramadol all that well though, so perhaps someone else can can chime in.


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## Yodeler123 (Oct 31, 2010)

You should never take tramadol with an SSRI OR SNRI. There is a risk of seratonin syndrome and seizures. 

A little tidbit also, pristiq is basically just effexor(venlafaxine). It's only purpose was because the patent on effexor ran out and that's just what drug companies do. They aren't going to make money off effexor when people can buy generics. So they make just enough change to a drug to get a new patent, rename it, and make money for another few years. Then repeat. Pristiq = effexor

The Chemical structure of tramadol is nearly identical to that of effexor ( venlafaxine )

I'm not saying your doc is wrong, he may be comfortable with the dosages and he probably has more insight into the interactions. Or he may be a bad doctor. I don't know. I do know that the interaction of tramadol and many psych meds is widely known. Tramadol by itself can cause fatal seizures by itself in high enough doses.


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## Kon (Oct 21, 2010)

"GENERALLY AVOID: Due to its serotonergic activity, coadministration of tramadol with serotonin-enhancing drugs such as SSRIs, SNRIs, nefazodone, trazodone, and mirtazapine may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Patients receiving tramadol with serotonin-enhancing drugs may also have an increased risk of seizures due to additive epileptogenic effects of these agents.

MANAGEMENT: In general, the use of tramadol in combination with highly serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life."

http://www.drugs.com/drug-interactions/pristiq-with-tramadol-2796-12488-2221-0.html


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## Vini Vidi Vici (Jul 4, 2009)

regardless of the theoretical risk of Serotonin syndrome, ---

It is the other meds that could cause more problems, by blocking or slowing the metabolism of Tramadol to the various active metabolites ( some of which, definitely contribute to the beneficial effects of Tramadol ). Tramadol itself has mechanisms which can be beneficial and sometimes positive,..... however, if the active/inactive metabolites aren't produced [ by other drugs blocking CYP2D6 ] , then Tramadol can build up to excessively high levels with repeat dosing.

Amphetamine might weakly inhibit CYP2D6. -- * there is a much higher risk of simply Amphetamine + Tramadol causing an interaction, or blocking each other's effects. The binding profile of Tramadol indicates that it could interfere with or block the positive effects of Amphetamine. My personal experiences with combining [ 5-10mgs Amphetamine + 25-50mgs Tramadol ], validate the assumption that the 2 drugs interact negatively. 12.5mgs Tramadol actually makes Amph more effective for me - but 25mg/up always completely blocks the positive/desired effects of Ampehetamine [ for me]...... but amplifies the negative side effects of both drugs - including , anxiety, panic attacks, ect.

Tramadol antagonizes the a-7 Nicotinic Acetylcholine receptor, ( a-7 activity is necessary for amphetamine to produce its Desired effetcs ), .......... similar to Memantine, -ish.

Inderal (Propronalol) has a possibility of causing negative interactions with Tramadol, ..... but even if a dangerous interaction does not occur between the two, Propranolol could be expected to terminate some/all of the desirable effects of Tramadol .,,,

[Assuming that you are combining the previously mentioned Meds at the same time, ] = if something stops working, the combo doesn't work at all, or novel side effects appear, the Lack of beneficial effects could definitely be attributed to each individual drug interfering with anothers desired mechanism.


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## Timboslice (Jul 28, 2010)

Vini Vidi Vici said:


> Tramadol antagonizes the a-7 Nicotinic Acetylcholine receptor, ( a-7 activity is necessary for amphetamine to produce its Desired effetcs ), .......... similar to Memantine, -ish.


Could you explain this a little further VVV? I knew that Tram and Amph basically canceled each other out, at least in dosing ranges that would be considered therapeutic. I also noted that Crazymed, in another thread mentioned that Memantine nullified amph effects at least early on. Is this the correlation? While I'm no longer taking Tramadol, I find that interesting as my brief time with Tram plus a Stim = neither of them working at all.


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## JohnG (Sep 3, 2010)

Timboslice said:


> Could you explain this a little further VVV? I knew that Tram and Amph basically canceled each other out, at least in dosing ranges that would be considered therapeutic. I also noted that Crazymed, in another thread mentioned that Memantine nullified amph effects at least early on. Is this the correlation? While I'm no longer taking Tramadol, I find that interesting as my brief time with Tram plus a Stim = neither of them working at all.


I'm also interested in the alfa-7-ACh-receptor antagonism and the block of effects of stims. VVV, do you have some studies maybe?


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## Vini Vidi Vici (Jul 4, 2009)

Timboslice said:


> Could you explain this a little further VVV? I knew that Tram and Amph basically canceled each other out, at least in dosing ranges that would be considered therapeutic. I also noted that Crazymed, in another thread mentioned that Memantine nullified amph effects at least early on. Is this the correlation? While I'm no longer taking Tramadol, I find that interesting as my brief time with Tram plus a Stim = neither of them working at all.


-- the *alpha-7 Nicotinic receptor*, has to be activated/agonized/active, in order for Amphetamine and various other similar (MDMA i think) stims to cause their desired effects. Amphetamine and MDMA reverse Dopamine (DAT), Serotonin, and Norepinephrine transporters, to varying degrees of potency. So, Amphetamine gets eaten by person.....then somehow it binds to the DAT, and reverses the DAT. I don't know how the DAT and a-7 Nicotinic Receptors are connected, just that if you antagonize a-7 receptors, it apparently blocks the DAT-reversal by Amphetamine.

Memantine and Tramadol both have multiple mechanisms that are relevant to this subject [ blocking effects of Dopamine-releasing Stims ]. -- the a-7 antagonism probably does contribute to the inhibitory actions of both substances, on Amphetamine-induced DA release. 5-HT3 antagonism could definitely reduce the amount of Dopamine released in response to Amphetamine ( and also lotsa other random stuff). Also, 5-HT3 modulates Cholecystokinin release/activity, therefore having an -indirect influencing role .....because Cholecystokinin (CCK) possesses significant manipulative influence on Dopamine release/activity. --------- //

- and the D2-agonist-something property of Memantine could also possibly contribute to the negative acute side effects. ----------//------

wow im tired , i have to come back later to finish this post



JohnG said:


> I'm also interested in the alfa-7-ACh-receptor antagonism and the block of effects of stims. VVV, do you have some studies maybe?


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## Gillian (Jul 26, 2011)

I was prescribed Pristiq for chronic depression as I have R/arthritis decided to leave tramadol off as do not like taking a lot of medications, as my pains got quite severe so when I need relief I take 1 tramadol with my 50gpristiq and found on more occasions that the lingering depression was always better on the days I took both. Will discuss this with my GP next visit:yes 
PS I have only been on Pristiq for 5 weeks wondering if I should have better results .


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