Major
Established
Description
Duloxetine, a serotonin-norepinephrine reuptake inhibitor, combined with tramadol markedly elevates the risk of serotonin syndrome.
Mécanisme
Both agents inhibit serotonin reuptake; duloxetine also inhibits norepinephrine reuptake, and tramadol's weak monoamine reuptake inhibition is additive.
Signification clinique
Regulatory agencies (FDA, EMA) include SNRI + tramadol as a named serotonin syndrome risk combination.
Prise en charge
Avoid concomitant use; select an opioid analgesic without serotonergic activity when treating pain in patients on duloxetine.