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