From the Guidelines
Tapentadol should be used with caution or avoided in patients taking SSRIs due to the risk of serotonin syndrome. This recommendation is based on the dual mechanism of action of tapentadol, which includes opioid receptor agonism and neurotransmitter reuptake inhibition, such as norepinephrine and serotonin 1. The use of tapentadol with SSRIs, which also increase serotonin levels, can lead to a significant increase in the risk of serotonin syndrome, a potentially life-threatening condition.
Some key points to consider when evaluating the use of tapentadol with SSRIs include:
- The risk of serotonin syndrome, which can present with symptoms such as agitation, hallucinations, rapid heart rate, fever, excessive sweating, shivering, tremors, muscle stiffness, coordination problems, nausea, vomiting, and diarrhea 1.
- The importance of consulting a healthcare provider for alternative pain relief options if you are currently taking an SSRI and require pain management.
- The need to inform all healthcare providers about all medications you are taking to prevent potentially harmful drug interactions.
In terms of the evidence, a study published in the Journal of the National Comprehensive Cancer Network in 2019 notes that tramadol and tapentadol should be used with caution or avoided in patients taking other serotonergic or monoamine oxidase inhibitors (MAOI)-like medications, such as SSRIs, due to the risk of serotonin syndrome 1. This study highlights the importance of careful consideration when prescribing tapentadol to patients taking SSRIs.
Overall, the potential risks associated with the use of tapentadol with SSRIs outweigh any potential benefits, and alternative pain relief options should be considered. If tapentadol is deemed necessary, close monitoring for signs of serotonin syndrome is essential, and patients should be educated on the risks and symptoms of this condition 1.
From the FDA Drug Label
Cases of serotonin syndrome, a potentially life-threatening condition, have been reported during concurrent use of tapentadol with serotonergic drugs Serotonergic drugs include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that affect the serotonergic neurotransmitter system (e. g. mirtazapine, trazodone, tramadol), and drugs that impair metabolism of serotonin (including MAO inhibitors, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue) [see Drug Interactions (7)].
Tapentadol can be used with SSRIs, but with caution. The use of tapentadol with SSRIs may increase the risk of serotonin syndrome, a potentially life-threatening condition.
- Monitor patients closely for signs and symptoms of serotonin syndrome, such as mental-status changes, autonomic instability, neuromuscular aberrations, and/or gastrointestinal symptoms.
- Discontinue tapentadol if serotonin syndrome is suspected 2.
From the Research
Tapentadol and SSRIs
- Tapentadol is a dual-acting central analgesic that combines µ-opioid receptor agonist activity with neuronal norepinephrine-reuptake inhibition in a single molecule 3, 4.
- The use of tapentadol with other central nervous system depressants, such as neuroleptics, opioids, illicit drugs, muscle relaxants, sedatives, and anxiolytics, requires caution 3.
- There is a potential risk of serotonin syndrome when combining selective serotonin reuptake inhibitors (SSRIs) with certain opioids, including tramadol 5, 6.
- Tapentadol, like tramadol, may also increase the risk of serotonin syndrome when used with SSRIs, although the risk is considered low 6.
- Studies have shown that tapentadol has a minimal effect on serotonin reuptake in vivo, which may suggest a lower risk of serotonin syndrome compared to other opioids 7.
Key Considerations
- The combination of tapentadol and SSRIs should be used with caution, and patients should be monitored for signs of serotonin syndrome 6.
- The benefits and risks of using tapentadol with SSRIs should be carefully weighed, and alternative analgesics may be considered if necessary 5, 7.
- Healthcare providers should be aware of the potential risks and take steps to minimize them, such as monitoring patients closely and adjusting dosages as needed 6.