Can you take Cymbalta and Tramadol together?

What is Cymbalta? What is Cymbalta used for?

Cymbalta is a Brand name for an antidepressant medicine that contains duloxetine as an active ingredient. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor antidepressant pharmacologically known as SSNRI that works by positively affecting nerve cell communication in the brain by restoring chemical balance.

Duloxetine can increase the levels of the neurotransmitters serotonin and norepinephrine, which actions may be mood regulation and may also block pain signals traveling through the brain.

Cymbalta is used for major depressive disorder treatment in adults. It is also indicated to treat anxiety disorders that last for at least 6 months, fibromyalgia, pain caused by diabetic nerve damage, chronic muscle pain or bone pain caused by osteoarthritis and stress urinary incontinence.

Cymbalta is available in the form of delayed release capsules in doses of: 20 mg, 30 mg and 60 mg. Duloxetine is also available in generic form.  FDA approved duloxetine in 2004 under the brand name Cymbalta and it is originally manufactured by Lilly drug company.

What is Tramadol? What is Tramadol used for?

Tramadol is the generic name for a prescription drug that is used as a moderate to severe pain reliever. It is sold under the brand names Ultram, Rybix ODT, Conzip and Ultram ER. It is also available in generic form.  The extended-release form of this drug is used for around-the-clock treatment of pain. Extended-release form of tramadol is not used on an as-needed basis for pain.

It is an opiate narcotic analgesic that works by changing the way how brain responds to pain. It may also increase levels of the neurotransmitters norepinephrine and serotonin. It also used in combination with acetaminophen. This combination is sold under the brand name Ultram.

Tramadol is available in the form of immediate-release tablet in doses of 50 mg and 100 mg, extended-release tablet in doses of 75 mg, 100 mg, 150 mg, 200 mg, 300 mg and 400 mg and extended-release capsules in doses of 100 mg, 150 mg, 200 mg and 300 mg to be taken by mouth. FDA approved tramadol in 1995 and it is originally manufactured by Janssen Pharmaceuticals.

How Cymbalta and Tramadol work in the body?

Duloxetine which is the active ingredient of Cymbalta works as a potent inhibitor of neuronal norepinephrine and serotonin reuptake and as a less potent inhibitor of dopamine reuptake. Duloxetine has no important affinity for adrenergic, dopaminergic, cholinergic, opioid, glutamate, histaminergic and affinity to GABA receptors.

The antidepressant and pain inhibitory actions of this drug are believed to be related to its potentiation of noradrenergic and serotonergic activity in the CNS. It is also thought that duloxetine activity is associated with the potentiation of serotonin and norepinephrine activity in the spinal cord, which increases urethral closure forces and thus lowering involuntary urine loss.

Tramadol has two mechanisms of action. In first, tramadol binds to μ-opioid receptors in the brain causing inhibition of ascending pathways which are responsible for perception of pain, and second one, tramadol can also inhibit reuptake of serotonin and norepinephrine. Tramadol may also lower threshold for seizure attacks because of its inhibitory effects on the serotonins 5-HT2C receptors.

This lowering of seizure threshold may be also attributed with tramadol’s antagonism on GABA receptors in the brain when it is taken in higher doses. In addition, tramadol’s active metabolite known as O-desmethyltramadol has a very high affinity to the δ-opioid receptors in the CNS, and by binding to these receptors it may provoke seizures in some individuals.

Cymbalta and tramadol Drug Interactions

Cymbalta and tramadol Drug Interactions

By using Cymbalta and Tramadol together you can increase the risk of a rare but very serious adverse condition known as serotonin syndrome, characterized with symptoms such as: confusion, seizure, hallucination, extreme changes in blood pressure, increased heart rate, excessive sweating, fever, blurred vision, muscle spasm or stiffness, stomach cramp, tremor, nausea, vomiting, and diarrhea.

The most severe cases may result in coma and even death.  This condition may be caused due to increased serotonergic activity, during administration of serotonin-enhancing drugs resulting with a hyperstimulation of brainstem 5-HT1A and 2A receptors.

You should call your health care provider immediately if you experience any of these symptoms while taking the medications. Using Cymbalta and Tramadol together may also increase the risk of seizures attacks which are not related to the serotonin syndrome.

This interaction may be more likely to happen in elderly, during undergoing alcohol or drug withdrawal or in those who have a history of seizures, or in patients with a condition of the central nervous system such as a brain tumor or head trauma. You should also avoid or limit the use of alcohol while being treated with these medications.

Cymbalta and Tramadol side effects

Cymbalta possible side effectsTramadol possible side effects
Nausea (23-25%)Constipation (24-46%)
Dry mouth (13-15%)Nausea (24-40%)
Headache (13-14%)Dizziness (10-33%)
Somnolence (10-12%)Vertigo (26-33%)
Fatigue (10-11%)Headache (18-32%)
Constipation (10%)Somnolence (7-25%)
Dizziness (10%)Vomiting (9-17%)
Insomnia (10%)Agitation (7-14%)
Diarrhea (9-10%)Anxiety (7-14%)
Anorexia (8%)Emotional lability (7-14%)
Decreased appetite (7-8%)Euphoria (7-14%)
Abdominal pain (6%)Hallucinations (7-14%)
Hyperhidrosis (6%)Nervousness (7-14%)
Increased sweating (6%)Spasticity (7-14%)
Agitation (5%)Dyspepsia (5-13%)
Nasopharyngitis (5%)Asthenia (6-12%)
Vomiting (3-5%)Pruritus (8-11%)
Male sexual dysfunction (2-5%) Diarrhea (5-10%)
Abdominal pain (4%)Dry mouth (5-10%)
Decreased libido (4%)Sweating (6-9%)
Musculoskeletal pain (4%)Hypertonia (1-5%)
Upper respiratory tract infection (URTI) (4%)Malaise (1-5%)
Abnormal orgasm (3%)Menopausal symptoms (1-5%)
Agitation (3%)Rash (1-5%)
Anxiety (3%)Urinary frequency (1-5%)
Blurred vision (3%)Urinary retention (1-5%)
Cough (3%)Vasodilation (1-5%)
Influenza (3%)
Muscle spasms (3%)
Tremor (3%)
Abnormal dreams (2%)
Dyspepsia (2%)
Hot flushes (2%)
Nausea (2%)
Oropharyngeal pain (2%)
Palpitations (2%)
Paresthesia (2%)
Weight loss (2%)
Yawning (2%)
Dysuria (>1%)
Gastritis (>1%)
Rash (>1%)

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