Mixing Celexa & Tramadol | Risks & Side Effects

Tramadol (Ultram, Conzip) an opioid analgesic (pain-reliever) is widely known to have secondary mood-elevating and antidepressant effects.

In contrast, Citalopram (Celexa) is a selective serotonin reuptake inhibitor (SSRI) similar to escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft). 

While concomitant use of these two drugs is common, both healthcare providers prescribing these medications and the patients using them should be aware of uncommon but possible adverse effects and drug interactions between these two serotonin-increasing substances.

Risks Of Mixing Tramadol & Celexa

Antidepressants counteract symptoms of depression by stimulating an increase in serotonin concentrations in the central nervous system. 

Serotonin is a neurotransmitter that influences activity across the body and mind with effects that relate to mood, sexual behavior, digestion, sleep, blood clotting, and more. 

Citalopram, acting as an SSRI, partially prevents neurons from absorbing serotonin (reuptake), increasing the amount of serotonin activity in the synapses. 

Tramadol, on the other hand, stimulates opioid receptors in the brain to provide analgesia (pain relief), while also partially preventing the reuptake of serotonin and a related neurotransmitter, norepinephrine. 

In combination, these two substances can potentially interact and increase serotonin levels past the point where it is helpful, with uncomfortable and potentially dangerous or even deadly results. This is known as serotonin syndrome.

Risk Of Serotonin Syndrome

Serotonin syndrome, also known as serotonin toxicity, can be caused by a single serotonergic (serotonin-increasing) drug.

This condition is more likely to occur when multiple serotonergic substances are used together, including citalopram and tramadol, or when substances are taken in high doses. 

Common serotonergic substances include:

• monoamine oxidase inhibitors (MAOIs)
• serotonin-norepinephrine reuptake inhibitors (SNRIs)
• selective serotonin reuptake inhibitors (SSRIs)
• tricyclic antidepressants 
• triptans
• some herbs, including nutmeg, ginseng, St. John’s wort, Syrian rue
• lithium

Serotonin syndrome can cause side effects like rapid heart rate (tachycardia) and high blood pressure (hypertension).

While fatal cases are rare, untreated serotonin syndrome can have life-threatening effects related to overheating, heart failure, seizures, or other organ failures.

Effects Of  Tramadol/Citalopram Use

Potential long-term side effects of mixing tramadol and citalopram may include:

• increased risk of type 2 diabetes
• heart rhythm changes
• reduced blood clotting/increased bleeding risk
• reduced sex drive/libido
• reduced sexual performance (impotence)
• difficulty orgasming
• tics or muscle spasms
• low-sodium levels (hyponatremia)
• physiological dependence and tolerance

When you mix two substances, you may also experience an increase in the side effects of both drugs.

Side-Effects Of Tramadol

Older adults are more likely to experience common side effects of tramadol, which  may include:

• sleepiness
• sleep disturbances
• headache
• nervousness
• shaking or shivering
• muscle tightness
• mood changes
• heartburn or indigestion
• dry mouth

Immediately contact a healthcare professional if you experience severe side effects like seizures, hallucinations, or heart rhythm changes.

Side Effects Of Celexa

Those who begin taking citalopram or other antidepressants may experience common side effects during the first few weeks of treatment, including:

• nausea or vomiting
• diarrhea or constipation
• stomach pain
• heartburn
• decreased appetite or weight loss (or gain)
• frequent urination
• excessive tiredness
• yawning
• weakness
• uncontrollable shaking of a part of the body
• muscle or joint pain
• dry mouth
• changes in sex drive or function
• heavy menstrual periods

Severe side effects can include suicidal thoughts, chest pain, fainting, or symptoms of serotonin syndrome.

Dependence & Withdrawal Symptoms

Unlike tramadol, which has considerable potential for addiction and abuse, citalopram is not euphoric or addictive. 

Nevertheless, the physical dependence on both drugs may develop with prolonged use, leading to uncomfortable withdrawal symptoms if a person stops taking one or both substances. 

To learn about our addiction treatment programs, please contact us today.