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Phase II hepatic metabolism renders the metabolites water-soluble, which are excreted by the kidneys. Thus, reduced doses may be used in renal and hepatic impairment.[13] Its volume of distribution is approximately 306 L after oral administration and 203 L after parenteral administration.[13]
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Summary: Since chronic pain syndromes and depression simultaneously occur in many patients, it is likely that tramadol and an SSRI will be used together. However, concomitant use of these drugs is known to increase the risk for seizures and serotonin syndrome (see the figure below).
Phase II hepatic metabolism renders the metabolites water-soluble, which are excreted by the kidneys. Thus, reduced doses may be used in renal and hepatic impairment.[13] Its volume of distribution is approximately 306 L after oral administration and 203 L after parenteral administration.[13]
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