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Tramadol is well-established as a serotonin reuptake inhibitor.[41][42] In addition, a few studies have found that it also acts as a serotonin releasing agent (1–10 μM), similar in effect to fenfluramine.[68][69][70][71] The serotonin releasing effects of tramadol could be blocked by sufficiently high concentrations of the serotonin reuptake inhibitor 6-nitroquipazine, which is in accordance with other serotonin releasing agents like fenfluramine and MDMA.[68][70][71]
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