A recent study has warned that taking the painkiller tramadol alongside certain commonly prescribed antidepressants could increase the risk of seizures in older adults. The research, published in Neurology, focused on nursing home residents and found that combining tramadol with antidepressants that inhibit the CYP2D6 enzyme may lead to potentially serious side effects.
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Tramadol’s metabolism is affected when the CYP2D6 enzyme is blocked, causing the drug to accumulate in the body. Antidepressants such as fluoxetine, paroxetine and bupropion act as CYP2D6 inhibitors. Researchers observed that this combination may raise the likelihood of seizures, regardless of which medication was started first, highlighting the need for caution when prescribing these drugs together.
The study analysed a decade of Medicare data, examining 70,156 nursing home residents aged 65 and over who had been prescribed both tramadol and an antidepressant. Findings revealed that seizure risk was approximately 9 per cent higher for patients taking tramadol with a CYP2D6-inhibiting antidepressant compared with those taking tramadol with an antidepressant that does not inhibit the enzyme. By contrast, another opioid painkiller, hydrocodone, was not linked to an increased seizure risk when combined with antidepressants.
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Lead author Yu-Jung Jenny Wei of The Ohio State University emphasised the importance of careful prescribing, particularly for older adults with complex health conditions. She noted that while the study relied on prescription records and cannot confirm exact drug intake, clinicians should remain alert to the potential risks of concomitant use of tramadol and CYP2D6-inhibiting antidepressants.
