I was thinking something more along the lines of hydrocodone. When Tramadol first came out, the thought was this new synthetic compound was NON-addictive. It isn't. It is called an opoid agonist, but I think there are some differences in terms of metabolism. I believe Tramadol could be classified as an SSRI, as much as an opiate. From what I have read, structurally it isn't an opiate.

I had a huge reaction to Tramadol that landed me in the ER, due to the serotonin agonistic effect.

Why risk liver toxicity due to some of these serotonergic drugs they have on the market? That SSRI clearance is an issue for some people, altho the orignal post wasn't about clearance, it was about an ineffective dose....which, I suppose could be a metabolism problem if all the enzyme pathways were already used, the tramdol wouldn't be broken down to the morphine metabolite?

I think there needs to be more testing of folks in terms of what their liver can metabolize.

I am sure MRSD will put in her 2 cents, and she knows more about this than I do. I just know if one is on an SSRI, that adding additional SSRI could be an issue. Polypharmacy is a big problem these days, not that opiates solve the problem, there are additional problems with opiates as well. But Tramadol is not the panacea that the pharmaceutical industry was hoping for. Unfortunately recreational users of these meds have made a mess for a lot of people. A lower dose of an opiate, can take the edge off for some folks....then again, one can't keep upping the dose hoping for complete relief. It's a quandry.