I've had two calls from pharmacists in the last few months regarding drug interactions with Tramadol. I can't say I'm an overall fan of this drug, but I am prescribing it at times. The last one was a SSRI interacting with Tramadol. I told the pharmacist to ignore the interaction. Today's was between Tramadol and almotriptan. It looks like goal here is to avoid multiple agents with serotonergic activity. Hmmm ... Yes, I get it, Serotonin Syndrome ... it certainly can be bad. That being said, 37.5mg of Tramadol and a 12.5mg of almotriptan (Axert) seems like pretty low risk. I would think that 40mg of citalopram and 400mg of Tramadol might be riskier ... but how risky is that ? I'm also thinking that my migraine patients might like a bit of the extra Serotonin. This drug interaction sounds like more benefit than risk. I'm also wondering does a tiny dose of tramadol and a tiny dose of almotriptan actually confer a MAJOR risk ? What I'd like to know is ... should I be getting calls when 2 drugs have anticholinergic effects ? That would be alot of work ! Hmmm ...
