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Serotonergic analgesic interaction — GPhC CRA MCQ

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HardDrug InteractionsSerotonergic analgesic interactionGPhC CRA

A 38-year-old woman taking tramadol 50 mg four times daily buys sumatriptan for migraine and takes sertraline 100 mg daily. She asks whether the combination is safe because she had sweating and tremor last night. What is the most important interaction to flag?

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Correct answer: D — Tramadol with sertraline increases serotonin-toxicity risk

Tramadol has serotonergic activity and can increase the risk of serotonin syndrome when combined with SSRIs. Sweating and tremor are concerning symptoms requiring assessment, especially if accompanied by agitation, diarrhoea, fever or clonus. Sumatriptan may add a theoretical serotonergic burden, but tramadol with sertraline is the key interaction here.

Reference: BNF