MajorOther opioids×SNRI (serotonin-norepinephrine reuptake inhibitor)
Updated · Methodology
Mechanism
Venlafaxine (SNRI) + tramadol – serotonin syndrome plus additive seizure risk. Tramadol itself is a weak serotonin-norepinephrine reuptake inhibitor with proconvulsant effect.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, fever.
Management
Avoid the combination. For analgesia on venlafaxine, use paracetamol, an NSAID, or morphine/oxycodone (without serotonergic activity). 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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Tramadol hydrochloride tablet (Amneal Pharmaceuticals NY LLC) – Prescribing Information (2017)– ; DailyMed setid 8ec4e4e5-a56e-4198-8428-6b770b9bf27d
- AEMPS: Ficha técnica: Venlafaxina (nº registro 67542), sección 4.5 (2024)– AEMPS, CIMA, nº registro 67542, revisión 03/2024, sección 4.5