Amitriptyline and Tramadol Interaction

Drug interactions and how to manage them can be very challenging and frustrating.  Let’s take a look at the amitriptyline and tramadol interaction.  Different sources report different potential interactions.

Medscape, both report different interactions on this one.  Medscape reports to monitor for increased serotonin levels as well as look out for both of these medications having sedative properties. which I tend to trust a little less says we should be concerned about monitoring for seizures.

This is the really frustrating part about drug interactions.  Many times there isn’t guidance about the severity and if there is the severity may differ depending upon the program you are using.  So, here is my thought process when looking at interactions like this with conflicting data;

  1. Has the patient been taking these meds for a while or is it a new start?
  2. Are both medications absolutely necessary and/or what alternatives exist?
  3. Does the patient already have a diagnosis that might make this interaction worse (i.e. are you starting tramadol in a patient that already has seizures)?
  4. What evidence, case reports exist?
  5. Dose.  Is the patient being started on a moderate to high dose?  Maybe they shouldn’t be if we are concerned about an interaction.
  6. Anticipate problems and educate the patient about what outcomes or adverse effects may be anticipated from a potential drug interaction.

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Written By Eric Christianson

January 11, 2017

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