Major
Escitalopram × Tramadol
Selective serotonin reuptake inhibitors (SSRIs)×Other opioids
Mechanism
Escitalopram (SSRI) raises synaptic serotonin; tramadol blocks serotonin and norepinephrine reuptake. Combined action sharply amplifies serotonergic transmission – serotonin syndrome risk.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia, dilated pupils. Autonomic features: sweating, tachycardia, hypertension, fever. First signs appear within hours of co-administration.
Management
Avoid the combination. For analgesia on escitalopram, use paracetamol, an NSAID, or morphine/oxycodone. For neuropathic pain, gabapentin or pregabalin.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.