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Dr. Bob is Robert Hsiung, MD,
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Posted by Dona on September 10, 2000, at 11:31:06
I take 40mg of prozac a day for depression. I recently had knee replacement surgery ( what a hard job that was!) and am tired of heavy narcotics for pain. Does anyone know if it is safe to take ultram? The literature says an increased seizure risk, but how often is this true? Thanks
Posted by Sunnely on September 10, 2000, at 20:48:10
In reply to Can I take ultram with prozac, posted by Dona on September 10, 2000, at 11:31:06
> I take 40mg of prozac a day for depression. I recently had knee replacement surgery ( what a hard job that was!) and am tired of heavy narcotics for pain. Does anyone know if it is safe to take ultram? The literature says an increased seizure risk, but how often is this true? Thanks
Hi Dona,
Indeed, the risk of seizures increases with the combined use of Ultram (tramadol) and antidepressants. I don't know the exact rate of occurrence, but I supposed it is related to the amount (dose), "pharmacokinetic" and other factors, and individual differences.
"Serotonin syndrome" is also a potential drug-drug interaction between Ultram and an SSRI (e.g., Prozac, Zoloft, Paxil, Luvox, Celexa), or the other serotonin-boosting antidepressants. Serotonin syndrome may include the following symptoms acute confusion, agitation, shivering, teeth-chattering, muscle rigidity, tremor, profuse sweating, rapid heart rate, rapid respiration, myoclonic jerks (muscle twitchings, jerking), and even seizures. Deaths from serotonin syndrome have been reported.
Ultram is a non-narcotic analgesic (pain killer). As an analgesic, it acts by binding to u-opiate receptors in the brain, altering the perception of and response to pain. In addition, it also inhibits the reuptake of serotonin and norepinephrine, which also modifies the pain pathway. Its reuptake inhibition of serotonin (and norepinephrine) may contribute to the increased risk of serotonin syndrome, if combined with the SSRIs.
Based on "pharmacokinetic" factors, theoretically, the likelihood of serotonin syndrome with the combination of Prozac and Ultram seems greater. FYI, Ultram is metabolized (broken down) by the liver enzyme called CYP2D6; Prozac is a potent inhibitor of the action of this liver enzyme. The combination of these drugs would lead to a decrease in the metabolism of Ultram, leading to an increase in its blood level, leading to an increase in serotonin effect, and eventually, serotonin syndrome.
Finally, Ultram, with its reuptake inhibition of serotonin and norepinephrine, may lead to increased risk of mania, especially in patients with bipolar disorder.
BTW, using a "pain killer" with codeine component along with Prozac may prove ineffective. Codeine is a "pro-drug," i.e., it has to be converted into an active compound (morphine) to be an effective "pain killer." To do so, it needs the intervention of the liver enzyme CYP2D6. Prozac, being a potent inhibitor of the action of this enzyme, prevents the conversion of codeine to morphine, hence, analgesic effect is not attained.
Just my own 2-cents.
References:
1. Mason BJ, Blackburn KH: Possible serotonin syndrome associated with tramadol and sertraline coadministration. Ann Pharmacotherapy 1997;31:175-177.
2. Watts B, Grady T: Tramadol-induced mania (letter). American Journal of Psychiatry 1997;154(November):1624.
3. Metabolic Drug Interactions 2000, Levy RH, Thummel KE, Trager WF, Hansten PD, Eichelbaum M (editors) Lippincott, Williams & Wilkins, Philadelphia.
Posted by jane on September 12, 2000, at 9:32:22
In reply to Re: Can I take ultram with prozac, posted by Sunnely on September 10, 2000, at 20:48:10
Sunnely-
I found your response to Dona very interesting; and as you can see I've changed the question a little. I take celexa in the AM but in the PM I take ultram, ambien, and elavil.
My first question seems naivee- what does a seizure feel like? Sometimes, every couple of weeks or months, while asleep (napping or night-time) I feel like someone gave me an electric shock at the base of the skull and at the same time I feel like I get a blow to the head (without the pain)and periodic limb movement. It seems to happen in seconds and afterwards I may or may not find my body contorted when I "wake" up.
I've had these events for years, initially maybe once a year,and now more often. (Ten years ago I did have a reaction to taking an MAOI and a TCA together one night (per pdoc instructions) but it was much worse and different symptoms; I had hot/cold flashes, legs couldn't move and couldn't speak for about 24hours. )
I can't tell what "causes" these events, they seem to be preceded by twelve or so hours of exhaustion and confusion and followed by 24 hours of exteme exhaustion and confusion.
I've never had anyone think they were important maybe because I can't describe them very well. Only recently have I started to pay attention to them. Since I can't predict them, I'm not sure how anybody would study them.
Can you help me fill in the blanks and what to look for or questions to ask?
thanks for the help- jane
Posted by SalArmy4me on March 15, 2001, at 19:22:42
In reply to Re: Can I take ultram with celexa-Sunnely, posted by jane on September 12, 2000, at 9:32:22
What you had were simple myoclonic jerks--very common with MAOIs. They go away with time.
> Sunnely-
> I found your response to Dona very interesting; and as you can see I've changed the question a little. I take celexa in the AM but in the PM I take ultram, ambien, and elavil.
> My first question seems naivee- what does a seizure feel like? Sometimes, every couple of weeks or months, while asleep (napping or night-time) I feel like someone gave me an electric shock at the base of the skull and at the same time I feel like I get a blow to the head (without the pain)and periodic limb movement. It seems to happen in seconds and afterwards I may or may not find my body contorted when I "wake" up.
> I've had these events for years, initially maybe once a year,and now more often. (Ten years ago I did have a reaction to taking an MAOI and a TCA together one night (per pdoc instructions) but it was much worse and different symptoms; I had hot/cold flashes, legs couldn't move and couldn't speak for about 24hours. )
> I can't tell what "causes" these events, they seem to be preceded by twelve or so hours of exhaustion and confusion and followed by 24 hours of exteme exhaustion and confusion.
> I've never had anyone think they were important maybe because I can't describe them very well. Only recently have I started to pay attention to them. Since I can't predict them, I'm not sure how anybody would study them.
> Can you help me fill in the blanks and what to look for or questions to ask?
> thanks for the help- jane
This is the end of the thread.
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