Interactions with other active ingredients | SSRI

Interactions with other active ingredients

Tramadol is a drug for the treatment of moderately severe to severe pain. It belongs to the group of opioids and is only available on prescription, but is not covered by the narcotics law in Germany. Serious interactions can occur when tramadol and SSRI are taken simultaneously.

An accumulation of the neurotransmitter serotonin can trigger the so-called serotonin syndrome. This is an up to life-threatening interaction of serotonin-enhancing drugs. Symptoms include an increase in blood pressure and pulse rate, sweating, nausea, vomiting, diarrhea, headaches, rapid breathing and dilation of the pupils.

In addition, internal and physical restlessness may occur, as well as hallucinations, coordination disorders or disturbances of consciousness. In some cases muscle twitching and seizures may occur. The occurrence of suicidal thoughts in connection with serotonin syndrome is also discussed.

For the treatment of serotonin syndrome, all serotonergic drugs must be discontinued and it may also be necessary to treat the symptoms with medication. Alcohol and SSRIs are generally a very unfavorable combination, as SSRIs can massively increase the effect of alcoholic drugs. Known effects of alcohol consumption, such as dizziness, nausea, motion sickness, may become so severe that total loss of control or unconsciousness may occur.Alcohol should also be avoided in view of the side effects of SSRI.

Since the drugs can already trigger an increased tendency to bleed and frequent alcohol consumption also has a negative effect on blood clotting, dangerous gastric or intestinal bleeding can occur if alcohol is consumed while taking SSRI. Bleeding of this kind brings symptoms such as vomiting blood or bloody stools. Gastrointestinal bleeding is a potentially life-threatening emergency that requires immediate treatment.

In the widely used SSRI citalopram, no interactions with oral contraceptives are known. Other SSRIs do not indicate a reduction in the efficacy of hormonal contraceptives either, as they are usually metabolized by another enzyme in the liver. In contrast to SSRIs, however, St. John’s wort, which is used to treat mild to moderate depression, can attenuate the effect of the pill. This is because St. John’s wort influences the enzyme responsible for the metabolism of contraceptives and can thus cause a loss of contraceptive effect. Patients undergoing treatment for depression should discuss the contraceptive therapy in detail with their gynecologist.