Major
citalopram × Tramadol
SSRI (selective serotonin reuptake inhibitor)×Other opioids
Mechanism
Dual risk. Citalopram (SSRI) raises synaptic serotonin and prolongs QT. Tramadol blocks serotonin and norepinephrine reuptake and lowers seizure threshold. Effects add up.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, hypertension, fever. First signs appear within hours of co-administration.
Management
Avoid the combination. For analgesia on citalopram, use paracetamol, an NSAID, or morphine/oxycodone. For neuropathic pain, gabapentin or pregabalin.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.