Tramadol + SNRI's (Venlafaxine)

[pally pete]

Hi all and merry christmas to our brothers and sisters in some parts of the world

My question is, im currently taking Venlafaxine 150mg ER per day and today as well as various benzos ive have already taken 400mg of Tramadol maybe 6 hours ago, would it be ok to ingest another 4oomg Tramadol now it would it be dangerous, and if so how long should i wait before i redose any Tramadol.

Thanks

(sorry if this has been answered many times in the past)

 

[effie]

The accepted maximum amount of tramadol in 24 hours is 400mg so you have already reached that. It obviously varies from person to person - some people can take more, but others have seized off less - so for the seizure risk alone you shouldn't take any more. Benzos are protective but you shouldn't let that make you complacent..

The other risk is serotonin syndrome. I once took 100mg tramadol on 150mg venlafaxine and I felt very uncomfortable indeed - very jittery, raised temperature, flushing, jaw clenching and nausea. I know this is anexdotal and I am not saying I had serotonin syndrome as in the life-threatening condition but it is a continuum and I certainly had exacerbated side effects along those lines - in my mind I am sure it was the combination of two serotinergic drugs which did it given the symptoms.

This drugs interaction checker shows a major interaction between tramadol and venlafaxine for this reason - they are both serotonergic (tramadol is infact an SNRI like venlafaxine) so they are not a safe combination to take at all.

 

[Allein]

I checked this out in some detail a while back as I'm on Venlafaxine and was being offered tramadol for free.

Its my understanding, which I think Effie has covered already but I'll go on (and on) anyway, that not only is there a risk of serotonin syndrome but that both substances lower your seizure threshold.

I actually said no to free drugs......this is the only time this has happened and hope it never happens again

 

[pally pete]

Thanks all.

No more Tramadol for me today/tonight then....... Time for the Oxy

Anybody know much about Pethidine?

 

[effie]

^ pethidine/meperidine may have slight serotonergic action too and there are some cases of serotonin syndrome.. but the biggest problem is it's toxicity. It's metabolite norpethidine is toxic and can cause seizures and delirium.

Sorry dude, looks like you are stuck with oxy!

 

[Jabberwocky]

hopefully meperidine, given it's second line treatment and the toxicity risk, is phased out as dextropropoxyphene has been in the US and now australia.

 

[effie]

^ indeed. It was used here a lot for biliary colic (gallstone pain) because it was thought to have antispasmodic activity, but it in fact does not so there is no reason to use it over other opioids at all.