In a new study, researchers found that common antidepressants can interact with the opioid pain medication tramadol and make it less effective for pain relief.
The finding may explain why some patients seek more effective pain relief and have a high risk of opioid addiction.
The research was conducted by a team from University Hospitals.
In the study, the team reviewed medication records of 152 patients who received scheduled painkiller drug tramadol for at least 24 hours.
They found that patients who also were taking the antidepressants Prozac (fluoxetine), Paxil (paroxetine) or Wellbutrin (bupropion) required three times more pain medication every day to control pain compared with patients not taking those antidepressants.
In a secondary analysis, it ended up being four times as much over their entire hospital stay.
So what explains the interaction between tramadol and these antidepressants?
The team says that tramadol relies on activation of an enzyme to give patients that pain control.
But this enzyme can be inhibited by medications such as fluoxetine, paroxetine, and bupropion.
According to the team, it’s likely that millions of Americans may be suffering the ill effects of this drug-to-drug interaction because these drugs are super-common.
In addition, chronic pain and depression and anxiety often occur in the same patient.
Many chronic pain patients are taking antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs), which could interact with painkiller tramadol.
But the team also says that this problem has a relatively easy fix.
People can take a lot of other antidepressants that don’t inhibit this particular enzyme, such as Zoloft (sertraline), (Celexa) citalopram and Lexapro (escitalopram).
They can also use other options for pain control—non-opioid medications such as NSAIDs.
If they need to use opioids, scheduled morphine or scheduled oxycodone would avoid this interaction.
This is the first study to document the effects of interaction between painkiller drug tramadol and these antidepressants in a real-world setting with patients.
The lead author of the study is Derek Frost, a pharmacist at UH.
The study is published in the journal Pharmacotherapy.
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