Tramadol contains an SSRI like component. How does this all interact with Cymbalta?

I sometimes wonder why not just give some one a low dose opiate? I have managed on mine for many years.

Generally not recommended. See: http://www.drugs.com/drug-interactio...73-2221-0.html

Not sure I understand; Tramadol is an opiate. Or did you mean something else?

Doc

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.

Sorry to post 2 times in a row, but, I am also one of those 'rare' cases who had a hideous reaction to Zofran (an SSRI type drug to stop nausea) and boy was this a doozy....movement disorder for days....and to make matters worse, the usual treatment is Benadryl, which does the same thing to me.

When I see some one not getting the prescribed effect from a drug, I wonder if they are not metabolizing or metabolizing too fast. That is when I look at what else they are one, to see if there is any one enzymatic pathway 'plugged' up, ala 'drug interaction'. More often than not, when it comes to pain treatment, an SSRI is involved.

There has been talk of how much tramadol is to much and the effects on the liver. My average is 150-200mg per day and really helps with the burning.

My thoughts are no point spending years in Pain and checking out with a pink super healthy liver, you cant use it when your gone!

As a matter of interest check out this tramadol abuse forum. keep in mind a vast number abusers are middle class . some of the doses are scary

http://www.medhelp.org/user_journals...y-Room-Part-14

I've been taking Tramadol for over 10 years, along with Lyrica
(previously with neurontin).
I take 100-150 per dose for a max of 300-400mg/day.
It sure helps me & I haven't seen a tolerance issue.

I would eat raw yak liver if it would cure this.

It binds to opiate receptors, much like hydrocodone and all opiates. Tolerance to the drug occurs the same as with opiates. Abrupt withdrawal of tramadol causes flu like symptoms. This can be found on the PDR site and other reliable sources. Although not classified as a controlled substance, do not be surprised if it goes on the list.

I'm not a chemist, and there are definitions, and there are definitions.

Using the Medical dictionary above, "opiate" is defined as:
As a derivative of codeine, tramadol fits that definition, and has many/most of the same characteristics: an opioid analgesic that can produce euphoria, dependency, tolerance, (opiate-like) withdrawal, and the potential for abuse/addiction.

Not trying to start a debate - just explaining my statement.

Doc

Not a debate, but important info to share. It is frightening for one to think their condition is deteriorating because more pain med is needed to control symptoms. In most cases also, esp in high dose control, stopping this med without another opioid on board will induce withdrawal symptoms similar to the heavier controlled pain meds. If one understands tolerance, it helps relieve some of the concern about worsening of PN. The use of any of this class of drugs causes the body's own endorphin production to slow down, thus less of nature's protective system is working, and over time more breakthrough pain. It only takes 3 days use to start reducing endorphins.

In addition to my critical care and ED work, I spent 6 year working in a medical detox, mostly teens and mostly opioids. Sorry to say, tramadol was a frequent flyer.