Drug interactions
Levomilnacipran + Tramadol
Severity: Major
Levomilnacipran and Tramadol: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Tramadol inhibits serotonin and norepinephrine reuptake, and levomilnacipran does the same, so the combination can lead to serotonin syndrome. Tramadol also lowers the seizure threshold, which adds to the concern. Symptoms include agitation, tremor, hyperthermia, clonus and autonomic instability.
What this interaction means in plain words
Levomilnacipran and Tramadol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Levomilnacipran belongs to Central Nervous System; Tramadol belongs to Musculoskeletal.
Why it happens
Additive serotonergic and noradrenergic reuptake inhibition, with added seizure threshold lowering.
What to do
Avoid the combination where possible and choose a non-serotonergic analgesic. If it is used, start at low doses and monitor for serotonin syndrome, especially after dose changes.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Tramadol
- Isocarboxazid + Tramadol Contraindicated
- Olanzapine / samidorphan + Tramadol Contraindicated
- Phenelzine + Tramadol Contraindicated
- Procarbazine + Tramadol Contraindicated
- Rasagiline + Tramadol Contraindicated
- Safinamide + Tramadol Contraindicated
Other interactions of Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Levomilnacipran with Tramadol?
MediHelp rates the interaction as major. Levomilnacipran and Tramadol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Tramadol inhibits serotonin and norepinephrine reuptake, and levomilnacipran does the same, so the combination can lead to serotonin syndrome. Tramadol also lowers the seizure threshold, which adds to the concern. Symptoms include agitation, tremor, hyperthermia, clonus and autonomic instability.
How serious is the interaction between Levomilnacipran and Tramadol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible and choose a non-serotonergic analgesic. If it is used, start at low doses and monitor for serotonin syndrome, especially after dose changes.
What other medicines interact with Tramadol?
MediHelp also lists interactions of Tramadol with, for example, Isocarboxazid, Olanzapine / samidorphan, Phenelzine. The full list is on the Tramadol page.
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