Drug General Information (ID: DDISM3UQ9P)
Drug Name			Eletriptan		Drug Info		Buprenorphine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antimigraine Agents				Analgesics
Structure

Mechanism of Eletriptan-Buprenorphine Interaction (Severity Level: Moderate)
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Eletriptan				Buprenorphine
Mechanism 1		CNS depression effects				CNS depression effects
Key Mechanism Factor 1
		Factor Name		CNS depression effects
		Factor Description		CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin.
Mechanism Description		Additive CNS depression effects by the combination of Eletriptan and Buprenorphine
Additive serotonergic effects Click to Show/Hide Mechanism Graph
Drug Name		Eletriptan				Buprenorphine
Mechanism 2		Serotonergic effects				Serotonergic effects
Key Mechanism Factor 2
		Factor Name		Serotonergic effects
		Factor Description		Serotonergic drugs include a variety of drugs that enhance or mimic the effects of the neurotransmitter serotonin. Excessive serotonergic activation may lead to a condition known as serotonin syndrome, in which high levels of serotonin in the brain cause the following symptoms: changes in blood pressure, coma, fever, increased heart rate, hallucinations, nausea, and seizures.
Mechanism Description		Additive serotonergic effects by the combination of Eletriptan and Buprenorphine

Recommended Action
Management		Caution is advised when opioids are used concomitantly with serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), other antidepressants/psychotropic agents (e.g., amoxapine, buspirone, lithium, maprotiline, mirtazepine, nefazodone, trazodone, vilazodone), 5-HT1 receptor agonists (triptans), 5-HT3 receptor antagonists, cyclobenzaprine, dextromethorphan, 5-hydroxytryptophan, and St. John's wort. Patients should be monitored for symptoms of the serotonin syndrome during treatment. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary.

References
1	Vizcaychipi MP, Walker S, Palazzo M "Serotonin syndrome triggered by tramadol." Br J Anaesth 99 (2007): 919. [PMID: 18006535]
2	Mittino D, Mula M, Monaco F "Serotonin syndrome associated with tramadol-sertraline coadministration." Clin Neuropharmacol 27 (2004): 150-1. [PMID: 15190240]
3	Das PK, Warkentin DI, Hewko R, Forrest DL "Serotonin syndrome after concomitant treatment with linezolid and meperidine." Clin Infect Dis 46 (2008): 264-5. [PMID: 18171260]
4	Gillman PK "Possible serotonin syndrome with moclobemide and pethidine." Med J Aust 162 (1995): 554. [PMID: 7776924]
5	Shakoor M, Ayub S, Ahad A, Ayub Z "Transient serotonin syndrome caused by concurrent use of tramadol and selective serotonin reuptake inhibitor." Am J Case Rep 15 (2014): 562-4. [PMID: 25540831]
6	Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6. [PMID: 8909274]
7	Mason BJ, Blackburn KH "Possible serotonin syndrome associated with tramadol and sertraline coadministration." Ann Pharmacother 31 (1997): 175-7. [PMID: 9034418]
8	Dougherty JA, Young H, Shafi T "Serotonin syndrome induced by amitriptyline, meperidine, and venlafaxine." Ann Pharmacother 36 (2002): 1647-1648. [PMID: 12243617]
9	US Food and Drug Administration (FDA) "FDA Drug Safety Communication: FDA warns about several safety issues with opioid pain medicines requires label changes.".
10	Kesavan S, Sobala GM "Serotonin syndrome with fluoxetine plus tramadol." J R Soc Med 92 (1999): 474-5. [PMID: 10645303]
11	Lange-Asschenfeldt C, Weigmann H, Hiemke C, Mann K "Serotonin syndrome as a result of fluoxetine in a patient with tramadol abuse: plasma level-correlated symptomatology." J Clin Psychopharmacol 22 (2002): 440-1. [PMID: 12172351]
12	Insler SR, Kraenzler EJ, Licina MG, Savage RM, Starr NJ "Cardiac surgery in a patient taking monoamine oxidase inhibitors - an adverse fentanyl reaction." Anesth Analg 78 (1994): 593-7. [PMID: 8109782]
13	Gonzalez-Pinto A, Imaz H, De Heredia JL, Gutierrez M, Mico JA "Mania and tramadol-fluoxetine combination." Am J Psychiatry 158 (2001): 964-5. [PMID: 11384912]
14	Hansen TE, Dieter K, Keepers GA "Interaction of fluoxetine and pentazocine." Am J Psychiatry 147 (1990): 949-50. [PMID: 2356884]
15	Egberts AC, ter Borg J, Brodie-Meijer CC "Serotonin syndrome attributed to tramadol addition to paroxetine therapy." Int Clin Psychopharmacol 12 (1997): 181-2. [PMID: 9248876]
16	Ailawadhi S, Sung KW, Carlson LA, Baer MR "Serotonin syndrome caused by interaction between citalopram and fentanyl." J Clin Pharm Ther 32 (2007): 199-202. [PMID: 17381671]
17	Noble WH, Baker A "MAO inhibitors and coronary artery surgery: a patient death." Can J Anaesth 39 (1992): 1061-6. [PMID: 1464133]
18	Venlafaxine + tramadol: serotonin syndrome. Prescrire Int 13 (2004): 57. [PMID: 15148976]
19	Rang ST, Field J, Irving C "Serotonin toxicity caused by an interaction between fentanyl and paroxetine." Can J Anaesth 55 (2008): 521-5. [PMID: 18676387]
20	Lantz MS, Buchalter EN, Giambanco V "Serotonin syndrome following the administration of tramadol with paroxetine." Int J Geriatr Psychiatry 13 (1998): 343-5. [PMID: 9658268]
21	Tissot TA "Probable meperidine-induced serotonin syndrome in a patient with a history of fluoxetine use." Anesthesiology 98 (2003): 1511-1512. [PMID: 12766667]
22	Meyer D, Halfin V "Toxicity secondary to meperidine in patients on monoamine oxidase inhibitors: a case report and critical review." J Clin Psychopharmacol 1 (1981): 319-21. [PMID: 7334144]
23	Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763. [PMID: 9330840]
24	Gnanadesigan N, Espinoza RT, Smith R, Israel M, Reuben DB "Interaction of serotonergic antidepressants and opioid analgesics: Is serotonin syndrome going undetected?" J Am Med Dir Assoc 6 (2005): 265-9. [PMID: 16005413]
25	Gillman PK "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth (2005):. [PMID: 16051647]
26	Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG "Serotonin syndrome resulting from drug interactions." Med J Aust 169 (1998): 523-5. [PMID: 9861909]
27	Roy S, Fortier LP "Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine." Can J Anaesth 50 (2003): 32-5. [PMID: 12514147]
28	Abadie D, Rousseau V, Logerot S, Cottin J, Montastruc JL, Montastruc F "Serotonin Syndrome: Analysis of Cases Registered in the French Pharmacovigilance Database." J Clin Psychopharmacol (2015):. [PMID: 26082973]
29	Houlihan DJ "Serotonin syndrome resulting from coadministration of tramadol, venlafaxine, and mirtazapine." Ann Pharmacother 38 (2004): 411-3. [PMID: 14970364]
30	Hillman AD, Witenko CJ, Sultan SM, Gala G "Serotonin syndrome caused by fentanyl and methadone in a burn injury." Pharmacotherapy 35 (2015): 112-7. [PMID: 25615513]
31	Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13. [PMID: 2035713]
32	Rosebraugh CJ, floxkhart DA, Yasuda SU, Woosley RL "Visual hallucination and tremor induced by sertraline and oxycodone in a bone marrow transplant patient." J Clin Pharmacol 41 (2001): 224-7. [PMID: 11210406]
33	Davis JJ, Buck NS, Swenson JD, Johnson KB, Greis PE "Serotonin syndrome manifesting as patient movement during total intravenous anesthesia with propofol and remifentanil." J Clin Anesth 25 (2013): 52-4. [PMID: 23391344]
34	Guo SL, Wu TJ, Liu CC, Ng CC, Chien CC, Sun HL "Meperidine-induced serotonin syndrome in a susceptible patient." Br J Anaesth (2009):. [PMID: 19556270]
35	Mateo-Carrasco H, Munoz-Aguilera EM, Garcia-Torrecillas JM, Abu Al-Robb H "Serotonin Syndrome Probably Triggered by a Morphine-Phenelzine Interaction." Pharmacotherapy (2015):. [PMID: 25903219]
36	Kitson R, Carr B "Tramadol and severe serotonin syndrome." Anaesthesia 60 (2005): 934-5. [PMID: 16115263]
37	Hunter B, Kleinert MM, Osatnik J, Soria E "Serotonergic syndrome and abnormal ocular movements: worsening of rigidity by remifentanil?" Anesth Analg 102 (2006): 1589. [PMID: 16632855]
38	Zornberg GL, Bodkin JA, Cohen BM "Severe adverse interaction between pethidine and selegiline." Lancet 337 (1991): 246. [PMID: 1670882]
39	Mahlberg R, Kunz D, Sasse J, Kirchheiner J "Serotonin syndrome with tramadol and citalopram." Am J Psychiatry 161 (2004): 1129. [PMID: 15169709]
40	Larson KJ, Wittwer ED, Nicholson WT, Weingarten TN, Price DL, Sprung J "Myoclonus in patient on fluoxetine after receiving fentanyl and low-dose methylene blue during sentinel lymph node biopsy." J Clin Anesth 27 (2015): 247-51. [PMID: 25499271]