Major
Established
Descripción
Combining escitalopram with tramadol substantially raises the risk of serotonin syndrome, a potentially life-threatening condition characterized by agitation, hyperthermia, tremor, and autonomic instability.
Mecanismo
Escitalopram inhibits serotonin reuptake (SERT); tramadol independently inhibits serotonin and norepinephrine reuptake while also being a weak mu-opioid agonist, producing additive serotonergic excess.
Relevancia clínica
Case series and pharmacovigilance databases document numerous cases of serotonin syndrome with this combination, including fatalities.
Manejo clínico
Avoid concurrent use; if analgesia is required, select a non-serotonergic opioid (e.g., morphine) under close clinical supervision.