From the Guidelines
No, it is not generally safe to take 50mg of tramadol and 50mg of trazodone together without medical supervision. These medications can interact and potentially cause serotonin syndrome, a serious condition that occurs when serotonin levels in your brain become too high. Tramadol, an opioid pain medication, and trazodone, an antidepressant, both affect serotonin levels in the brain. When combined, they can increase the risk of side effects including confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, high fever, seizures, and in severe cases, loss of consciousness. Additionally, both medications can cause drowsiness and central nervous system depression, which may be dangerous when combined. According to the study published in the Journal of the National Comprehensive Cancer Network 1, tramadol and tapentadol should be used with caution or avoided in patients taking other serotonergic or monoamine oxidase inhibitors (MAOI)-like medications due to the risk of serotonin syndrome. The Mayo Clinic Proceedings study 1 also highlights the risk of serotonin syndrome when combining tramadol with certain medications, including selective serotonin reuptake inhibitors (SSRIs). If you have prescriptions for both medications, consult with your healthcare provider before taking them together. They can evaluate your specific situation, potentially adjust dosages, or suggest alternative medications that don't interact. Never adjust medication dosages or combine prescription drugs without professional medical guidance. It's also worth noting that the American Academy of Sleep Medicine clinical practice guideline 1 suggests that clinicians should not use trazodone as a treatment for sleep onset or sleep maintenance insomnia, which may be relevant if you're taking trazodone for sleep-related issues. However, the primary concern with combining tramadol and trazodone is the risk of serotonin syndrome, as highlighted in the studies 1.
From the FDA Drug Label
Tramadol hydrochloride should be used with caution and in reduced dosages when administered to patients receiving CNS depressants such as alcohol, opioids, anesthetic agents, narcotics, phenothiazines, tranquilizers or sedative hypnotics. Because of its added depressant effects, tramadol should be prescribed with caution for those patients whose medical condition requires the concomitant administration of sedatives, tranquilizers, muscle relaxants, antidepressants, or other CNS depressant drugs.
The combination of 50mg of tramadol and 50mg of trazodone may increase the risk of central nervous system (CNS) depression and respiratory depression. It is recommended to use tramadol with caution and in reduced dosages when administered with other CNS depressants, including antidepressants like trazodone. Therefore, taking 50mg of tramadol and 50mg of trazodone together may not be safe and should be done under the guidance of a healthcare professional, with careful monitoring of the patient's condition 2.
From the Research
Safety of Combining Tramadol and Trazodone
- The combination of tramadol (an opioid analgesic) and trazodone (an antidepressant) may pose a risk of serotonin syndrome, a potentially life-threatening condition 3, 4.
- However, a study published in 2014 suggests that the risk of serotonin syndrome is modest, and tramadol can be safely combined with antidepressants, including trazodone, with proper monitoring and counseling 5.
- The study also notes that increased age, higher dosages, and use of concomitant potent cytochrome P450 2D6 inhibitors may increase the risk of serotonin syndrome 5.
- Another study published in 2018 highlights the importance of prompt recognition and management of serotonin syndrome and seizures, which can be effectively treated by administering benzodiazepines, providing supportive care, and discontinuing tramadol and other contributing agents 6.
- A case report published in 2000 describes a lethal combination of tramadol and multiple drugs affecting serotonin, including trazodone, which resulted in seizure activity and death 4.
- A study published in 2015 found that tramadol overdose was associated with a significant risk of seizures and respiratory depression, but serotonin toxicity was unlikely 7.
Dosage and Risk Factors
- The dosage of 50mg of tramadol and 50mg of trazodone is relatively low, but the risk of serotonin syndrome and seizures cannot be ruled out entirely.
- Patients should be monitored closely for signs of serotonin syndrome, such as agitation, confusion, severe shivering, diaphoresis, myoclonus, hyperreflexia, mydriasis, tachycardia, and fever 3.
- The concomitant use of other serotonergic agents, such as selective serotonin reuptake inhibitors or neuroleptics, may increase the risk of serotonin syndrome and seizures 6, 4.