Major
Established
Mô tả
Fluoxetine combined with tramadol carries a high risk of serotonin syndrome and additionally reduces tramadol's analgesic efficacy via CYP2D6 inhibition.
Cơ chế
Fluoxetine is a potent CYP2D6 inhibitor, blocking the conversion of tramadol to its active M1 metabolite, while both agents increase synaptic serotonin, producing dual pharmacokinetic and pharmacodynamic risk.
Ý nghĩa lâm sàng
Risk of serotonin syndrome is well-documented; concurrent CYP2D6 inhibition also renders tramadol less effective as an analgesic.
Xử trí
Avoid the combination; use alternative analgesics and consult prescribing guidelines for SSRI management around pain procedures.