Can Tramadol And Effexor Be Taken Together?

Our pharmacist answers the latest question regarding an interaction between Effexor (venlafaxine) and tramadol.


Can tramadol & Effexor be taken together?

Asked by Kelly On Sep 29, 2017

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Sep 29, 2017

Ultram (Tramadol) and Effexor (Venlafaxine) can be taken together, but there is a possible drug interaction between the two and there often may be a better choice of a drug combination to avoid the drug interaction. 

Both drugs work on the neurotransmitter serotonin and increase levels of it in the brain. Having too much serotonin can cause a slew of problems including two afflictions known as serotonin syndrome and neuroleptic malignant syndrome. Serotonin syndrome is characterized by rapid development of hyperthermia, high blood pressure, rigidity, mental status changes (e.g., delirium or coma), and in rare cases, death.

In one known case, the addition of tramadol to extended-release venlafaxine (300 mg/day) and mirtazapine (30 mg/day) likely caused serotonin syndrome. A patient developed agitation, confusion, severe shivering, tachycardia, and fever within 7 weeks of taking tramadol 400 mg daily. He had taken 300 mg tramadol without difficulty. Discontinuation of the 3 drugs and rehydration led to symptom resolution over 36 hours. Because of this, patients receiving tramadol in combination with an SNRI should be monitored for the emergence of serotonin syndrome, neuroleptic malignant syndrome-like reactions, or other adverse effects.Now, the reported cases of serotonin syndrome have be in people who were taking high doses regularly of both drugs. 

I have seen many patients on the combination without a problem, you just need to be sure to be monitored for side effects. Sometimes a change in pain medication however, is a prudent choice.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Office: 716-389-3076

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