skip to main content

Tramadol Serotonin Syndrome Risk — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

HardPain MedicineTramadol Serotonin Syndrome RiskFRCA Final

A 42-year-old man with chronic low back pain has been prescribed tramadol 100 mg QDS. He also takes sertraline 100 mg daily for depression and ondansetron 8 mg TDS for nausea from another medication. What dangerous drug interaction exists?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Tramadol and sertraline cause serotonin syndrome

Tramadol has serotonin reuptake inhibition properties in addition to its opioid and noradrenergic effects. When combined with a selective serotonin reuptake inhibitor (SSRI) such as sertraline, there is a significant risk of serotonin syndrome – a potentially fatal condition characterised by hyperthermia, rigidity, myoclonus, autonomic instability, and altered consciousness. This combination should be avoided or used with extreme caution at the lowest effective doses with close monitoring. Other serotonergic drugs (MAOIs, SNRIs, St John's wort) also interact.

Reference: BNF – 2025 – Tramadol interactions; NICE – 2020 – CG173 Neuropathic pain; RCOA – 2023 – Pain medicine