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