escitalopram and tramadol

Both drugs increase serotonergic activity in the central nervous system. Escitalopram is a selective serotonin reuptake inhibitor (SSRI), while tramadol is a weak opioid that also inhibits serotonin and norepinephrine reuptake and enhances serotonin release. The additive effects can lead to excessive serotonin at synaptic clefts, precipitating serotonin syndrome. Additionally, both drugs lower the seizure threshold, potentially increasing the risk of seizures.

Patients may develop serotonin syndrome, characterised by agitation, confusion, hyperthermia, diaphoresis, tremor, hyperreflexia, myoclonus, and diarrhoea. Severe cases can progress to rhabdomyolysis, seizures, cardiovascular instability, and death. There is also an increased risk of seizures due to the combined proconvulsant effects. Symptoms can appear within hours to days of starting the combination.

Avoid concurrent use when possible. If the combination is considered necessary, use the lowest effective doses, and monitor patients closely for signs of serotonin syndrome, especially during dose escalation. Educate patients to seek immediate medical attention if they experience symptoms. Consider alternative analgesics with lower serotonergic activity.

Well established in the literature through case reports and clinical observations. Recognised as a major interaction in multiple drug interaction resources.