Mania induced by tramadol-venlafaxine combination

Nousha Hefzi, BA, MBA; Jeremy Grekin, MS; Aisha Ahmed, MD

doi:10.5055/jom.2019.0519

Authors

Nousha Hefzi, BA, MBA
Jeremy Grekin, MS
Aisha Ahmed, MD

DOI:

https://doi.org/10.5055/jom.2019.0519

Keywords:

tramadol, mania, manic, venlafaxine, SNRI

Abstract

A 49-year-old male with major depressive disorder well-managed with venlafaxine [serotonin and norepinephrine reuptake inhibitor (SNRI)] and no history of manic episodes developed his first manic episode following use of tramadol. Tramadol-induced mania has been described with selective serotonin reuptake inhibitors but not SNRIs. In addition, mania is not listed as a potential clinical side effect—further illustrating this relative rarity. Due to tramadol’s SNRI activity, there is definitive risk for mood lability in individuals managed with tramadol and other serotonergic medications as seen in this patient. The authors findings suggest the need for greater risk consideration when prescribing tramadol with other related agents such as venlafaxine.

Author Biographies

Nousha Hefzi, BA, MBA

Wayne State University School of Medicine, Detroit, Michigan

Jeremy Grekin, MS

Wayne State University School of Medicine, Detroit, Michigan

Aisha Ahmed, MD

Henry Ford Hospital, Detroit, Michigan

References

Minami K, Ogata J, Uezono Y: What is the main mechanism of tramadol? Naunyn Schmiedebergs Arch Pharmacol. 2015; 388(10): 999-1007.

Ansermot N, Chocron O, Herrera F, et al.: Severe manic episode associated with tramadol in a patient with recurrent depressive disorder. J Clin Psychopharmacol. 2015; 35(2): 203-204.

Gonzalez-Pinto A, Imaz H, De Heredia JL, et al.: Mania and tramadol-fluoxetine combination. Am J Psychiatry. 2001; 158(6): 964-965.

Sharma V: Tramadol-induced hypomania and serotonin syndrome. Prim Care Companion CNS Disord. 2016; 18(6). doi:10.4088/PCC.16l01975. Available at https://www.psychiatrist.com/PCC/article/Pages/2016/v18n06/16l01975.aspx. Accessed April 30, 2019.

John AP, Koloth R: Severe serotonin toxicity and manic switch induced by combined use of tramadol and paroxetine. Aust N Z J Psychiatry. 2007; 41(2): 192-193.

Ceylan D, Kaçar M, Ulas H: Manic episodes associated with tramadol: A case report. J Clin Psychopharmacol. 2015; 35(1): 111-113.

Watts BV, Grady TA: Tramadol-induced mania. Am J Psychiatry. 1997; 154(11): 1624.

Nimah J, Chen A, Gable KN, et al.: Tramadol-associated mania: A case report. J Opioid Manag. 2017; 13(3): 197-200.

Alfaro CL, Lam YW, Simpson J, et al.: CYP2D6 inhibition by fluoxetine, paroxetine, sertraline, and venlafaxine in a crossover study: Intraindividual variability and plasma concentration correlations. J Clin Pharmacol. 2000; 40(1): 58-66.

Rajabizadeh G, Kheradmand A, Nasirian M: Psychosis following tramadol withdrawal. Addict Health. 2009; 1(1): 58-61.