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Interacting Drugs

OBJECT DRUGS

Opioid Analgesics (Serotonergic):

PRECIPITANT DRUGS

SSRI and SNRI:


Comment:

There have been a number of cases of serotonin syndrome following the combined use of serotonergic analgesics such as meperidine or tramadol with selective serotonin reuptake inhibitors (SSRI) or selective serotonin-norepinephrine reuptake inhibitors (SNRI). One case of fatal serotonin syndrome was reported in a patient on amitriptyline following the addition of tramadol. Limited evidence suggests that fentanyl may also exhibit additive serotonergic effects with other serotonergic drugs, but more evidence is needed. Use particular care if the SSRI or SNRI is also an inhibitor of the metabolism of the opioid.


Class 3: Assess Risk & Take Action if Necessary