POSSIBLE SEROTONIN SYNDROME-ASSOCIATED WITH TRAMADOL AND SERTRALINE COADMINISTRATION

OBJECTIVE: To report a possible case of serotonin syndrome associated with coadministration of tramadol hydrochloride and sertraline hydroch loride. CASE SUMMARY: A 42-year-old woman developed atypical chest pai n, sinus tachycardia, confusion, psychosis, sundowning, agitation, dia phoresis, and tremor. She was taking multiple medications, including t ramadol and sertraline. The tramadol dosage had recently been increase d, resulting in what was believed to be a serotonergic syndrome. DISCU SSION: Serotonin syndrome is a toxic hyperserotonergic state that deve lops soon after initiation or dosage increments of the offending agent . Patients may differ in their susceptibility to the development of se rotonin syndrome. The (+) enantiomer of tramadol inhibits serotonin up take. Tramadol is metabolized to an active metabolite, M1, by the CYP2 D6 enzyme. If this metabolite has less serotonergic activity than tram adol, inhibition of CYP2D6 by sertraline could have been a factor in t he interaction. CONCLUSIONS: Clinicians should be aware of the potenti al for serotonin syndrome with concomitant administration of sertralin e and tramadol.