I think Tramadol is useful for some. I use 1/2 tablet (25mg) only at night for tough days. (this is to avoid tolerance).

I also get nausea sometimes with it...so I use it carefully.

You cannot really use it with SSRIs or SNRIs safely, as the risk of seizures increases and also serotonin syndrome.

Tramadol needs to be activated by the liver to its active metabolites, so there is a delay in onset from when you swallow your dose. Some people mistake this delay for it not working and up doses when that is not necessary. And some people lack the liver enzyme to activate it at all ...so it won't work well for them.

I personally like it because the next day, I am virtually pain free..so a very little goes a LONG WAY for me.

But response is all very personal depending on your genetics and particulars.

Thanks, mrsD,

I have read similar things about combining TCA's (Nortriptyline) and Tramadol. I have also read that the combination is used often, though, and without incident, according to patient reviews. Maybe I live dangerously? LOL. I took half a tablet this AM & after more than an hour, I felt only a small improvement. I took the other half, 2 hours after the 1st, and noticed a bit more.

Although relief was better for me, initially with Nortriptyline, and before that, Gabapentin, my feet felt reasonably good the rest of the day on the Tramadol, into the afternoon. I've been prescribed 3 daily, & probably won't take more than one daily, and 2 on my "rough" days, when I really don't feel like dealing with it. The only side effect I may have had was a bit of gurgling in my stomach from my breakfast. Maybe not.

mrsD,

What is your personal take on the use of Tramadol with a Tricyclic antidepressant? There are warnings on the Drug Interaction Checkers online, but, as I've noted, they are often prescribed together. My Pharmacist, here in a small town, knows me by name, but made no comments on it.

When the TCA is a very low dose, the interaction potential is low.

This warning rises, as the TCA dose (and or Tramadol dose) increases.

People with high serotonin levels to begin with...would be more at risk. You can gauge this by the side effects from Tramadol occurring at the lower dose levels... like nausea, dizziness etc.

Because people vary so much, there is really no one rule to fit everyone equally.

Would those kinds of side effects be indicative of too much serotonin or too little?

Doc

There are high serotonin people and low serotonin people.

People with higher levels normally are more sensitive to any drug that raises serotonin in the body. They are typically the ones who cannot stand SSRIs or have long term side effects from them. So adding in Tramadol for them is just more serotonin, if only a little more. These people are thought to be more anxious and more highly mentally aroused than others. They avoid high risk and anxiety activities too. These may be those who get the itching side effect from some synthetic opiates too.

The TCAs don't raise serotonin as fast or as much as the SSRIs and SNRIs. But they do raise it some, and more with increasingly high doses.

I take Tramadol 50mg morning and night, although my Doctor has permitted me to take up to 8 a day if necessary, I've managed to keep to these 2 tablets for quite a while now.

I take Tramadol for the burning, stinging sensations, and it does a great job. Overall, I'd say it controls the pain quite well, not 100%, but good enough to let me get on with things.

I also take Lyrica, primarily for the electric shock pain. I don't know if Lyrica contributes to the stinging, pins & needles also. Thinking to go off it soon and investigate whether Tramadol alone could keep my pain in check.

Tramadol does not seem to effect other pain. For example, I can still suffer a headeache, or stomach cramps.

Hope that's of some help toward your question.