A new study shows that older adults in nursing homes may have a higher chance of having seizures if they take the pain medicine tramadol together with certain antidepressants.
The study, published in the journal Neurology, found a link between these drugs and seizures, but it didn’t prove that one directly causes the other.
Tramadol is a strong painkiller used for moderate to severe pain. Some antidepressants can interfere with how tramadol is processed in the body.
These antidepressants block an enzyme called CYP2D6, which is needed to break down tramadol.
When this enzyme is blocked, tramadol may build up in the body, which could increase the risk of side effects like seizures. Common antidepressants that block CYP2D6 include fluoxetine, paroxetine, and bupropion.
Researchers from The Ohio State University looked at 10 years of Medicare data and studied over 70,000 nursing home residents aged 65 and older who had been prescribed both tramadol and an antidepressant.
The participants were divided into two groups: one group took tramadol first and then an antidepressant, while the other group took an antidepressant first and later added tramadol.
In the group that took tramadol first, the seizure rate was 16 seizures per 100 person-years. In the group that took antidepressants first, the rate was 20 seizures per 100 person-years. This means that for every 100 people using both drugs for one year, 16 to 20 people were diagnosed with seizures.
Researchers then looked more closely at whether the antidepressants blocked the CYP2D6 enzyme. In people who took tramadol first, those using antidepressants that block CYP2D6 had a seizure rate of 18 per 100 person-years, compared to 16 for those using other antidepressants.
In the group who took antidepressants first, the seizure rate was 22 for those using CYP2D6-blocking drugs and 20 for others.
To make sure the results weren’t caused by other health problems, the researchers adjusted for factors like how much pain the person had, their mental health, physical abilities, and memory.
After making these adjustments, they found that the seizure risk was 9% higher for people who took tramadol with a CYP2D6-blocking antidepressant (when tramadol came first) and about 6% higher when the antidepressant came first.
To check if the problem was specific to tramadol, the researchers also looked at another pain medicine called hydrocodone. Hydrocodone is not likely to increase seizure risk. They found no increase in seizures when people took hydrocodone with antidepressants, even if the antidepressants blocked CYP2D6.
This suggests that the risk is specific to tramadol and not all opioids.
The lead researcher, Dr. Yu-Jung Jenny Wei, says this shows doctors need to be careful when prescribing these medications to older people. Because both tramadol and antidepressants are commonly used in seniors, it’s important to understand how they may affect each other.
One weakness of the study is that it relied on prescription records, which don’t show whether patients actually took the medicine as prescribed.
This study highlights the need for doctors and patients to talk carefully about medication risks, especially when dealing with complex health issues in older adults.
If you care about pain, please read studies about Scientists find a new way to manage knee pain and findings of Promising new drug offers hope for chronic nerve pain relief.
For more about pain, please read studies about Chronic morphine use for cancer pain may increase bone loss and findings of Scientists find a new hope for chronic pain.
Copyright © 2025 Knowridge Science Report. All rights reserved.
