Is it safe to use Seroquel (quetiapine) and tramadol concurrently?

From the Guidelines

Using Seroquel (quetiapine) and tramadol together is not recommended due to the risk of serious interactions, including central nervous system depression and serotonin syndrome. The combination of these medications can increase the risk of excessive sedation, confusion, respiratory depression, and other life-threatening conditions [ 1 ]. Seroquel, an antipsychotic, blocks dopamine and serotonin receptors, while tramadol, an opioid pain medication, also has serotonergic effects. When combined, they can enhance each other's sedative effects, potentially causing serotonin syndrome, characterized by agitation, hallucinations, rapid heart rate, fever, excessive sweating, shivering, muscle stiffness, and seizures.

Key considerations when evaluating the safety of this combination include:

• The risk of central nervous system depression, which can be life-threatening
• The potential for serotonin syndrome, a serious condition that requires immediate medical attention
• The need for close monitoring and potential dosage adjustments if both medications are deemed necessary for treatment
• The importance of consulting a healthcare provider before adjusting or stopping prescribed medications

It is essential to prioritize caution when combining medications with serotonergic effects, such as Seroquel and tramadol, due to the potential for dangerous interactions [ 1 ]. If you are currently prescribed both medications, consult your healthcare provider immediately to discuss the risks and potential alternatives for your treatment.

From the Research

Safety of Concurrent Use of Seroquel and Tramadol

• The concurrent use of Seroquel (quetiapine) and tramadol may pose a risk of serotonin syndrome, a potentially life-threatening condition 2, 3.
• A case report describes a 36-year-old man who died after developing seizure activity while being treated with tramadol, venlafaxine, trazodone, and quetiapine, all of which interact with the neurotransmitter serotonin 4.
• Another case report highlights the risk of transient serotonin syndrome caused by the concurrent use of tramadol and a selective serotonin reuptake inhibitor (SSRI) 3.
• A review of case reports suggests that the concomitant use of tramadol with antidepressants, including SSRIs, may increase the risk of serotonin syndrome, but this does not constitute a contraindication to their use 2.
• The risk of serotonin syndrome can be minimized by monitoring and counseling patients, especially when starting a new serotonergic agent or increasing doses 2.

Factors Influencing the Risk of Serotonin Syndrome

• Increased age, higher dosages, and use of concomitant potent cytochrome P450 2D6 inhibitors may increase the risk of serotonin syndrome 2.
• The use of tramadol with MAOIs is contraindicated, but it can be safely combined with other antidepressants, including SSRIs and SNRIs 2, 5.
• Physicians should be aware of the potential interaction between tramadol and SSRIs/SNRIs and take a comprehensive individual benefit-risk assessment when prescribing tramadol to patients using these medications 6.

Clinical Implications

• Clinicians should be vigilant for signs of serotonin syndrome, including altered mental status, neuromuscular and autonomic nervous system excitation, and altered mental state, when prescribing tramadol to patients using serotonergic medications 3, 6.
• Hospital pharmacies can play an important role in signaling the potential interaction and providing information on the benefits and risks of tramadol and alternative analgesics in the presence of SSRIs or SNRIs 6.