Mason B J, Blackburn K H
College of Pharmacy, Idaho State University, Boise, USA.
Ann Pharmacother. 1997 Feb;31(2):175-7. doi: 10.1177/106002809703100208.
To report a possible case of serotonin syndrome associated with coadministration of tramadol hydrochloride and sertraline hydrochloride.
A 42-year-old woman developed atypical chest pain, sinus tachycardia, confusion, psychosis, sundowning, agitation, diaphoresis, and tremor. She was taking multiple medications, including tramadol and sertraline. The tramadol dosage had recently been increased, resulting in what was believed to be serotonergic syndrome.
Serotonin syndrome is a toxic hyperserotonergic state that develops soon after initiation or dosage increments of the offending agent. Patients may differ in their susceptibility to the development of serotonin syndrome. The (+) enantiomer of tramadol inhibits serotonin uptake. Tramadol is metabolized to an active metabolite, M1, by the CYP2D6 enzyme. If this metabolite has less serotonergic activity than tramadol, inhibition of CYP2D6 by sertraline could have been a factor in the interaction.
Clinicians should be aware of the potential for serotonin syndrome with concomitant administration of sertraline and tramadol.
报告一例可能与联用盐酸曲马多和盐酸舍曲林相关的血清素综合征病例。
一名42岁女性出现非典型胸痛、窦性心动过速、意识模糊、精神错乱、日落综合征、躁动、多汗和震颤。她正在服用多种药物，包括曲马多和舍曲林。曲马多剂量最近有所增加，导致了疑似血清素能综合征。
血清素综合征是一种毒性高血清素能状态，在引发药物开始使用或剂量增加后不久就会出现。患者对血清素综合征的易感性可能存在差异。曲马多的（+）对映体抑制血清素摄取。曲马多通过CYP2D6酶代谢为活性代谢物M1。如果这种代谢物的血清素能活性低于曲马多，舍曲林对CYP2D6的抑制可能是相互作用的一个因素。
临床医生应意识到舍曲林和曲马多联用可能导致血清素综合征。
