Major
Established
Deskripsi
Sertraline and tramadol together significantly increase serotonergic tone, posing a clinically meaningful risk of serotonin syndrome.
Mekanisme
Sertraline inhibits SERT-mediated serotonin reuptake; tramadol also inhibits serotonin and norepinephrine reuptake, resulting in additive serotonin accumulation in CNS synapses.
Signifikansi Klinis
Multiple published case reports and regulatory warnings document serotonin syndrome with this combination.
Penatalaksanaan
Avoid concurrent use; if tramadol is unavoidable, start at the lowest dose, titrate slowly, and monitor closely for signs of serotonin toxicity.