Tramadol Serotonin Syndrome

What About Tramadol?

What is Serotonin Syndrome?

Serotonin syndrome is a severe drug reaction. It is caused by medications that build up high serotonin levels in the body. Serotonin is a chemical that the body produces naturally. It’s needed for the nerve cells and brain to function. But too much serotonin causes signs and symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever, and seizures). Severe serotonin syndrome can cause death if not treated [3].

Serotonin syndrome can happen when you increase the dose of certain medications or start taking a new drug. It’s most often caused by combining medications that contain serotonin, such as an antidepressant and migraine medication. In addition, some illicit drugs and dietary supplements are linked with serotonin syndrome.

Milder forms of serotonin syndrome may go away within a day or two of stopping the medications that cause symptoms and, sometimes, after taking drugs that block serotonin. Moderate cases can be treated as above with the addition of a serotonin antagonist and admission to the hospital for cardiac monitoring and observation. In severe, life-threatening cases, the patient should be treated as above with the addition of sedation, paralysis, and intubation/ventilation in the intensive care unit.

Serotonin Syndrome Symptoms

Your body makes serotonin to help your brain cells, and other nervous system cells communicate with each other. Researchers think a lack of serotonin in your brain may play a role in depression. But too much of it can lead to extreme nerve cell activity and dangerous symptoms.

Serotonin syndrome symptoms often begin hours after you take a new medication that affects your serotonin levels or after you raise your dose of a current drug. Symptoms may include:

In severe cases, serotonin syndrome can be life-threatening. Call 911 or go to the emergency room if you have any of these symptoms:

Serotonin Syndrome Causes and Risk Factors

Medications usually cause serotonin syndrome, especially certain antidepressants. You might be at higher risk if you take two or more drugs and/or supplements that affect your serotonin levels.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressants. They work by raising your serotonin levels. These drugs include:

How Does Tramadol Cause Serotonin Syndrome?

Tramadol is a pain reliever that works by altering how the brain and nervous system react to pain. In addition to being a mu-opioid receptor, this drug inhibits the reuptake of serotonin and norepinephrine in the brain. Tramadol increases the concentration of serotonin in the synapses between the serotonergic neurons found in the brain stem. This extra serotonin causes some of the positive effects of the medication, such as pain relief.

If too much serotonin builds up in the synapses between the brain cells, this can lead to serotonin toxicity, also known as serotonin syndrome. Using this opioid pain medication alone could result in serotonin syndrome, mainly if a person takes too much of the medication or takes more than prescribed.

There is a bigger risk when taking Tramadol: serotonin syndrome and seizures which can be caused by many factors, including:

Are there Risk Factors for this Interaction?

Tramadol accounts for a significant number of drug interactions. For example, an Australian veterans study examined adverse drug interactions in 46,859 participants taking antidepressants. Of the 8.1 percent who experienced these interactions, tramadol was the most often implicated drug (3.6%).

Of these various interactions, this opioid pain medication has the potential to trigger two dramatic events—seizures and serotonin syndrome. These may develop during tramadol monotherapy either at routine or excessive doses but are particularly likely during tramadol coadministration with antidepressants. In addition to antidepressants, this drug may interact with a number of other psychotropic drugs, including antipsychotics and anticonvulsants.

How is Serotonin Syndrome Identified?

No single test can confirm a serotonin syndrome diagnosis. Your doctor will diagnose the condition by ruling out other possibilities. Your doctor will likely begin by asking about your symptoms, medical history, and any medications you’re taking. Your doctor will also conduct a physical examination.

To make sure your symptoms are caused by serotonin syndrome and not due to another cause, your doctor may use tests to:

• Measure levels of any drugs you’re using
• Check for signs of infection
• Check body functions that may be affected by serotonin syndrome

A number of conditions can cause symptoms similar to those of serotonin syndrome. Minor symptoms can be caused by several conditions. Moderate and severe symptoms similar to those of serotonin syndrome could be caused by:

• A serious reaction to certain medications, such as some anesthetics, antipsychotic drugs and other agents known to produce these severe reactions
• An overdose of illicit drugs, antidepressant medications or other medications that increase serotonin levels
• Damage associated with illicit drug use
• Severe alcohol withdrawal

Your doctor may order additional tests to rule out other causes of your symptoms. Tests may include:

• Blood and urine tests
• Chest X-ray
• CT scan
• Spinal tap (lumbar puncture)

Tramadol Addiction

Many people are unaware of the addictive nature of Tramadol. If you are taking more of this drug than your doctor prescribed or are exhibiting drug-seeking behaviors, it is possible that you have developed an addiction. Combining this prescription drug with other drugs increases the risks of experiencing side effects.

Failing to follow the doctor’s instructions on how to use any medication is risky, but Tramadol overuse can lead to dependence and addiction. The World Health Organization studied the effect of of this drug and found it creates the same craving response as any other opioid medication. This craving causes people to consume more of the drug, eventually leading to Tramadol addiction.

Signs of Tramadol Addiction

Substance use disorders, like those involving tramadol, are not always easy to recognize. Thus, diagnosis is best left to a medical professional. However, if within a 12-month period you or a loved one show two or more of the following examples of problematic tramadol use, you may meet the criteria for diagnosis of a substance use disorder involving tramadol.

The Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria for an opioid use disorder involving tramadol include: