I agree with your MD & pharmacist. Theoretically, it's best not to combine these meds...but many people take both all the time with no major problems. Here is the exact nature of the interactions:
1) sertraline + tramadol
sertraline will increase the level or effect of tramadol by affecting its liver metabolism. (so basically, you should always start with a low dose of tramadol...even half the usual dose if you want to be conservative & play it safe)
2) sertraline + tramadol
sertraline and tramadol both increase serotonin levels. This really doesn't matter. The risk of serotonin syndrome is rare. You can review the symptoms of this syndrome & just keep an eye out for it. I've seen patients on maximum doses of 2-3 antidepressants and tramadol who haven't had this syndrome.
3) sertraline + tramadol
sertraline decreases effects of tramadol by decreasing metabolism. This effect is milder than the 1st 2, and it actually counteracts the 1st effect mentioned above.
It's fine to try to slowly wean off clonazepam, but I would do one thing at a time to play it safe. You have three goals: 1) lower zoloft, 2) add
tramadol, and 3) lower clonazepam...doing one thing at a time is the gentlest way to succed.
I hope this helps. Let me know if you need more info.
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