Can Tramadol And Effexor Be Taken Together?

Our pharmacist answers the latest question regarding an interaction between Effexor (venlafaxine) and tramadol.

Sep 29, 2017

Kelly asked

Can tramadol and Effexor be taken together?

At a glance

  • The combination of tramadol and Effexor (venlafaxine) can cause a rare, but serious condition known as serotonin syndrome.


Ultram (Tramadol) and Effexor (Venlafaxine) can be taken together in certain situations, but there is a possible drug interaction between the two. I many cases, there is a better choice of a drug combination to avoid the drug interaction.

Both drugs work on the neurotransmitter serotonin and increase concentrations of it in the brain.

Too much serotonin can lead to a rare, but serious condition known as serotonin syndrome. Serotonin syndrome is characterized by the rapid development of several symptoms, including:

  • Hyperthermia
  • High blood pressure
  • Muscle rigidity
  • Mental status changes

Tramadol, being an opioid medication, isn't often associated with having effects on serotonin, but it does and needs to be considered.

In fact, in 2016, the FDA released a safety communication regarding the potential for serotonin syndrome and opioid medication. 

There have been several case studies published that have linked tramadol to cases of serotonin syndrome. One such case study stated the following:

A 47-year-old white man receiving combined mirtazapine and venlafaxine therapy for major depressive disorder developed agitation, confusion, severe shivering, diaphoresis, myoclonus, hyperreflexia, mydriasis, tachycardia, and fever on coadministration of tramadol for chronic pain. An objective causality assessment revealed that the addition of tramadol was the probable cause of the adverse reaction.

The overall point is that there is the potential for serotonin syndrome when combining tramadol and venlafaxine. The chances of it occurring are thought to be small, but it is extremely serious if it does occur.

In many cases, there likely is a better combination of drugs that carries less risk. If your doctor does recommend both together, you need to be sure to monitor for side effects.

  1. FDA Drug Safety Communication: FDA warns about several safety issues with opioid pain medicines; requires label changes. FDA
  2. Serotonin syndrome resulting from coadministration of tramadol, venlafaxine, and mirtazapine. PubMed
  3. Effexor Prescribing Information. AccessFDA
  4. Ultram Prescribing Information. AccessFDA

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