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  • BDD Moderators: Keif’ Richards

Combo: Tramadol + Cymbalta

S

SPC123

Bluelighter
Joined
Apr 7, 2009
Messages
640
I have some pretty bad chronic wrist pain as a result of a break. I was on the strong narcotics for a while but ran into problems with tolerance and dependence. I have been off of them for two weeks, but no matter what I try to manage my pain it remains intolerable.

I spoke to my doctor today and he is very much against prescribing more strong opiates. We both ultimately decided on tramadol. He gave me a few bottles each of instant and extended release. I am already taking 60mg Cymbalta daily for anxiety.

Can I use 300mg tramadol in addition to my Cymbalta or should I replace my daily Cymbalta dose? I know it's not an ideal situation but I can't physically tolerate codeine and none of the powerful opiates were an option. Thanks for taking the time to read!
 
Don't combine them, they're both SNRIs, so taking them together is gonna put you at risk of serotonin syndrome.

Tramadol itself has similar effects to cymbalta, so it may help with your anxiety as well as your pain. If you can't manage without both of them, i'd advise just going back to your doctor and seeing what sort of compromise you can figure out.
 
^ To parrot nAON - Do NOT combine them. Your doctor is putting you at risk by Rx'ing you these two chemicals.

We can't help you talk to your doctor, but what I can say - if your doctor isn't providing you the services you feel you need, you're well within your rights as a patient to seek help elsewhere (get a new, more intelligent, doctor).
 
I really like my doctor. Been with the guy for over 20 years. The tramadol was my idea. He gave it to me free and he gives me my Cymbalta free as well. I will stop taking the Cymbalta while I take the tramadol. I have to say, I took some tramadol a bit ago and it's already helping my pain. It's not 100% but it's enough that I don't want to cut my arm off. :)
 
If you can get by with that, get rid of the Cymbalta totally. Maybe the Tramadol will help with your anxiety as well. If not - perhaps add a benzo if you haven't before? I find that (personally) clonazepam works very well with Tramadol. However I HATE Tram's SNRI effects in me (and limits my use of my DOC - LSD due to it's serotonergic effects).

If you find it doesn't - discuss o-desmethyl-tramadol with him. It's Tramadol's metabolite that's responsible for the opiate-like analgesia (it's not a proper opiate). This doesn't have an SNRI profile, and you could take it with the Cymbalta.
 
Ahh, thanks! I never knew that was an option. I have a clonazepam scrip from the same doc but I really don't like to take it regularly.
 
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ODT is rarely mentioned; I hadn't heard of it until I joined BL either.

Good luck!
 
One other question... Is it possible for tramadol to INCREASE pain? I took a 300ER about 4 hours ago and my wrist is developing a stabbing pain that wasn't there before...
 
That would be a new one for me... doesn't seem logical, but that's not always the best source of reason. I'd wait for someone else to chime in.

Have you been using it in a particular fashion? Try doing some stretches if you haven't already.

Good luck!
 
I have tried a bunch of things. I used to be on 480mg of oxycodone at my peak (4 x 80 ER, 4 x 20 IR). I spoke with a pharmacist this evening who told me if I have never had a seizure before it was so unlikely that tramadol would cause one, even in addition to my Cymbalta, that it wasn't worth worrying about. She told me to be aware of the signs of serotonin syndrome so that I could get to the hospital in the unlikely event it occurred. She said that since the Cymbalta has a different mechanism of action than the SNRI properties of tramadol I shouldn't skip the dose.
 
SPC123 said:
One other question... Is it possible for tramadol to INCREASE pain? I took a 300ER about 4 hours ago and my wrist is developing a stabbing pain that wasn't there before...
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I take tramadol for ankle pain, altho I don't take it daily. Anyway, I developed an achy type pain in my ankle since startin the tram. Could be a coinsidence. Not really sure but it's odd you also developed a different pain.
 
I don't know why your pharmacist seems so unconcerned with the combination of Cymbalta and tramadol, as they both do have SNRI properties, and serotonin syndrome is a possibility, and not a terribly remote one. Also, the combination of the two would lower your seizure threshold. Tramadol alone can easily provoke a seizure at the right dose, so your pharmacist's laissez-faire attitude about the risks are a little concerning. I would choose one or the other if those are the only two available to you.
 
Well she told me that there are several people she deals with on the same meds. She says she calls the prescribing doctor to ensure they are aware of the conflict and they never seem overly concerned. She said she has even seen a person on a TCA + Cymbalta + tramadol. Seems crazy to me, but I figure if someone can survive that I can survive tramadol and Cymbalta.
 
SPC123 said:
Well she told me that there are several people she deals with on the same meds. She says she calls the prescribing doctor to ensure they are aware of the conflict and they never seem overly concerned. She said she has even seen a person on a TCA + Cymbalta + tramadol. Seems crazy to me, but I figure if someone can survive that I can survive tramadol and Cymbalta.
Click to expand...

That is faulty logic, never assume you can handle a certain combo just because someone else can handle an even riskier combo.
 
Oh I know. My point was more that it obviously isn't a guaranteed seizure. Besides, a seizure might not be a bad thing. It might spur my doctor to prescribe me a useful drug. That is, if the seizure doesn't kill me...
 
SPC123 said:
Oh I know. My point was more that it obviously isn't a guaranteed seizure. Besides, a seizure might not be a bad thing. It might spur my doctor to prescribe me a useful drug. That is, if the seizure doesn't kill me...
Click to expand...

I would not look at a seizure as a good thing, even if not fatal could have horrible consequences. Suppose you were driving while it happened or suppose you hit your head if you collapsed possibly causing a true seizure disorder. There is one place where a seizure can be seen as a beneficial thing, and that is ECT. Short of ECT seizures aren't "good" in any way. If you want your doctor to rx you better drugs talk to him, tell him of your concerns and your pain, and if he doesn't do anything good about it find another doc.
 
My doctor is very good. He doesn't want to prescribe me opiates because of the problems I have had with them this time around. I "lost" my pills a couple too many times. :(
 
All we can say is discuss the situation with your doctor.

Taking two serotonin reuptake inhibitors actually isn't as dangerous as taking a serotonin releaser (eg MDMA, DXM, LSD) with a reuptake inhibitor but max dose tramadol plus an SSRI definitely couldn't be said to be 100% safe.

PJ, I don't think o-desmethyltramadol is available on prescription, it's a RC opioid as far as I am aware.. it is in the UK anyway, could be different elsewhere.
 
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