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I take Cymbalta along with Norco, Ultram and various other meds. Does the Norco or Ultram weaken the effects of Cymbalta. I seem to be on edge quite often lately.


Yes, Ultram (tramadol) can react with Cymbalta and should not be taken in conjunction with Cymbalta.

GENERALLY AVOID: Coadministration of tramadol, which has serotonergic activity, and serotonin reuptake inhibitors (Cymbalta) may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors. Patients receiving this combination of drugs may also experience an increased risk of seizures.

MANAGEMENT: In general, the use of tramadol in combination with serotonin reuptake inhibitors should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Close monitoring is recommended for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, delirium, hallucinations, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia.