Tramadol + bupropion/fluoxetine/paroxetine — ↓ activation
- Tramadol needs CYP2D6 → active M1
- 2D6 inhibitors ↓ opioid analgesic effect
- Parent tramadol may accumulate instead
- serotonergic/seizure toxicity can rise
- Avoid strong CYP2D6 inhibitors if possible
- Use analgesic not dependent on CYP2D6
Interaction at a glance
- Parent tramadol may accumulate instead
- serotonergic/seizure toxicity can rise
- Avoid strong CYP2D6 inhibitors if possible
Management
- Tramadol needs CYP2D6 → active M1
- Avoid strong CYP2D6 inhibitors if possible
Clinical consequence
- 2D6 inhibitors ↓ opioid analgesic effect
- Parent tramadol may accumulate instead
- serotonergic/seizure toxicity can rise
Mechanism
- Use analgesic not dependent on CYP2D6
Self-check
- What is the main clinical risk of Tramadol + bupropion/fluoxetine/paroxetine?
serotonergic/seizure toxicity can rise.
- What is the preferred management of Tramadol + bupropion/fluoxetine/paroxetine?
Avoid strong CYP2D6 inhibitors if possible.
- What active metabolite is formed from Tramadol?
M1.
Drugs in this interaction (4)
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