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Pharmacy/pristiq/deptran/tramadol interaction?


Hi, I am currently on 300 mgs of Pristiq (desvenlafaxine)taken in the morning, plus 50-100 mgs of an older anti-depressant, Deptran (doxepin hydrochloride)at night.

I was under the impression that mixing these drugs with the painkiller tramadol was an absolute no-no. But the other day I had a shocking migraine and ended up taking 100 mgs of tramadol out of desperation, and I was fine and felt much better (I already had the tramadol at home from my pre-anti-depressant days, but had not bothered to chuck it out: it was not out of date or anything).

I'm interested in this because soon I am having a major surgery which I have been told will cause moderate to severe pain for some weeks. I have already told the hospital I should not have tramadol, but if it's actually okay for me to have it in moderate doses I would rather have tramadol than things like oxycontin etc, since in my experience tramadol doesn't cause physical dependence or make me tired.

Given what I have told you, do you think tramadol in moderation might be okay after all?


If you are going to have major surgery soon, you must check with your physician ALL medications you will be taking before, during, and after the surgery, including tramadol.  I am sorry, but I am not in a position to give you the okay to take tramadol in moderation post surgery.  Surgery often does cause moderate to severe pain.  Tramadol may not be an effective pain reliever post surgery and the MD may prescribe something stronger or non oral (ie intravenous morphine).  Although you stated tramadol does not cause physical dependence or make you tired, it may in the future, similar to any other prescription pain killer.  

In terms of taking pristiq with doxepin with tramadol, as long as your MD says it is okay you can take these three together.  Yes, they do interact with one another.  

Hope this helps!



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Nanaz Khosrowshahi


Being a pharmacist, I can answer questions on medications. This includes how drugs work in the body, drug interactions, drug side effects, warnings and precautions to take when using certain medications, dosage forms and strengths, management of overdosing, storage of medications, drug administration, contraindications, and drug indications. I am able to guide them on lab work that needs to be drawn and monitored while on certain medications. I am able to help patients save money when purchasing medications by directing them to cost-effective therapies. I am able to answer questions on federal laws governing pharmacy practice in the United States. I am unable to answer questions legally as if I am diagnosing the patient's disease or illness. For example, if a patient stated he had upper flank pain, I am unable to say he definitely has a urinary tract infection. However, I am able to direct the patient to the correct next step, which is to call his physician with such a side effect.


I have been a licensed pharmacist since 2007, holding licenses in CT and MA. I have a PHARM.D from an accelerated pharmacy school program. Currently, I work at the Hebrew Home and Hospital in West Hartford, CT as a pharmacist. I am a well-rounded pharmacist, with experience in long-term care, IV home infusion, retail, hospital, and hospice. I serve as the pharmacy unit coordinator for Mass Dispensing Area #31 in CT, where I am called upon as a volunteer pharmacist in case of public emergencies, such as anthrax threats. I helped run the swine flu vaccine clinic in 2009. I am on the Editorial Advisory Board for Pharmacy Today, a publication of the American Pharmacists Association. My position on the board runs for three years. Every month I make suggestions and offer ideas that would help improve the magazine. I have undergone extra training to administer vaccines to patients, which is training that only a certain percentage of registered pharmacists in the country have.

American Pharmacists Association 2007

Massachusetts College of Pharmacy and Health Sciences, Worcester, MA- PHARM.D 2007 University of California, Irvine- BA psychology 2001 cum laude

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