Letter to the Editor: Serotonin syndrome following the administration of tramadol with paroxetine

Lantz, Melinda; Buchalter, E N; Giambanco, Vincent

doi:10.1002/(sici)1099-1166(199805)13:5<343::aid-gps771>3.0.co;2-5

Cited by 36 publications

(19 citation statements)

References 18 publications

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“…Tramadol is a synthetic opioid-like drug, and the exact mechanism of action of tramadol in delaying ejaculation is not well known, but its weak serotonin- and noradrenaline-reuptake inhibitory action is unlikely to be the only explanation for its effectiveness in patients with PE. It is possible that it has other central actions on serotonin receptors, but this hypothesis requires further investigation [18] .…”

Section: Discussionmentioning

confidence: 99%

On-demand use of tramadol, sildenafil, paroxetine and local anaesthetics for the management of premature ejaculation: A randomised placebo-controlled clinical trial

Gameel

Tawfik

Abou-Farha

et al. 2013

Arab Journal of Urology

103

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ObjectivesTo compare the clinical efficacy of the on-demand use of four drugs in the management of patients with premature ejaculation (PE), as the off-label use of selective serotonin-reuptake inhibitors and topical penile anaesthetics is frequently indicated for the management of patients with PE, and tramadol HCl and sildenafil citrate were also tried for managing this disorder, but with recommendations based on weak evidence.Patients and methodsThis was a single-centre, single-blind, placebo-controlled clinical trial conducted on 150 patients who had PE for >1 year. Patients were randomised equally into five groups. On-demand tramadol, sildenafil, paroxetine, local lidocaine gel or placebo was given for patients in groups 1–5, respectively. During the month before treatment, the intravaginal ejaculation latency time (IELT) and sexual satisfaction scores (on a 0–5-point scale) were measured and compared to the mean IELT and sexual satisfaction scores recorded during 4 weeks of on-demand drug administration, with monitoring of any possible side-effects.ResultsTramadol-treated patients had a significantly longer mean (SD) IELT, of 351 (119) s, than the other groups. Local anaesthetic was significantly better than paroxetine in prolonging the IELT, at 278 (111) vs. 186 (65) s, respectively. The improvement in sexual satisfaction was significantly better in the sildenafil group, with a mean (SD) improvement of 2.9 (1) points, than in the paroxetine and local anaesthetic groups, at 2.2 (0.9) and 1.9 (0.9) points, respectively.ConclusionsThe four drugs significantly improved IELT values over placebo. Tramadol was associated with significantly longer IELT values, whilst sildenafil induced significantly better sexual satisfaction than the other drugs. The four drugs had tolerable side-effects.

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Section: Discussionmentioning

confidence: 99%

On-demand use of tramadol, sildenafil, paroxetine and local anaesthetics for the management of premature ejaculation: A randomised placebo-controlled clinical trial

Gameel

Tawfik

Abou-Farha

et al. 2013

Arab Journal of Urology

103

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“…The fact that many of these patients had delayed ejaculation or anejaculation inspired the use of Tramadol empirically since 2000 in patients with PE. The second factor was the available data about serotonin syndrome with over dosage of Tramadol, or combination treatment with Tramadol and SSRIs [19]. Recently, in February 2006, Safarinejad and Hosseini [14] published the first study on the on‐demand use of 50 mg Tramadol to treat PE showing a significant effect of 50 mg dosage.…”

Section: Discussionmentioning

confidence: 99%

Tramadol HCL has Promise in On-Demand Use to Treat Premature Ejaculation

Salem

Wilson

Bissada

et al. 2008

The Journal of Sexual Medicine

151

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Introduction Premature ejaculation (PE) is a worldwide problem without an approved treatment. Selective serotonin reuptake inhibitors (SSRIs) are widely used “off label” as pharmacotherapeutic agents in the treatment of PE. Aim This study investigates Tramadol efficacy for on-demand treatment of PE. Main Outcomes Measures Intravaginal ejaculation latency time (IELT) was used as an objective tool to assess the efficacy of the investigated treatments. Materials and Methods Single-blind, placebo-controlled, crossover, stopwatch monitored two-period study was conducted, on 60 patients with lifelong PE. PE was defined as IELT of <2 minutes in 80% of intercourse episodes. A total of 25 mg of Tramadol hydrochloride was given to one group (30) prior to intercourse and placebo was supplied for the other group (30) for 8 weeks. Drugs were taken 1–2 hours before sexual activity and sexual intercourse was required at least once per week. After the initial treatment period, the two groups took the alternate medication for another 2 months. The two 8-week treatment periods were separated by 1 week washout period. IELT was timed by a stopwatch at each intercourse and was reported by patients or partners. Results The baseline (mean ± SD) IELT for patients before treatment was 1.17 ± 0.39 minutes. At the end of the treatment period utilizing the active drug, the mean IELT was increased significantly in patients on Tramadol treatment to 7.37 ± 2.53 minutes. The same patients on placebo medication had mean IELT of only 2.01 ± 0.71 minutes. Patients uniformly reported satisfaction with their resulting control over ejaculation. Conclusions Tramadol, a drug with a proven safety record as an anti-inflammatory agent, shows promise as a drug for treating rapid ejaculation.

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“…Because both tramadol and SSRIs influence the serotonin system, there is a theoretic risk of serotonin syndrome developing with concomitant exposure in patients. Reports of serotonin syndrome during concomitant intake of tramadol and SSRIs, specifically including paroxetine, have previously been published 43 , 44 , 45 . Tramadol has been prescribed in Europe for nearly 3 decades.…”

Section: Discussionmentioning

confidence: 99%

Paroxetine, a cytochrome P450 2D6 inhibitor, diminishes the stereoselective -demethylation and reduces the hypoalgesic effect of tramadol

Laugesen¹,

Enggaard²,

Pedersen³

et al. 2005

Clinical Pharmacology & Therapeutics

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Letter to the Editor: Serotonin syndrome following the administration of tramadol with paroxetine

Cited by 36 publications

References 18 publications

On-demand use of tramadol, sildenafil, paroxetine and local anaesthetics for the management of premature ejaculation: A randomised placebo-controlled clinical trial

On-demand use of tramadol, sildenafil, paroxetine and local anaesthetics for the management of premature ejaculation: A randomised placebo-controlled clinical trial

Tramadol HCL has Promise in On-Demand Use to Treat Premature Ejaculation

Paroxetine, a cytochrome P450 2D6 inhibitor, diminishes the stereoselective -demethylation and reduces the hypoalgesic effect of tramadol

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