Name a medication that can precipitate serotonin syndrome when combined with SSRIs.

• A. Ibuprofen
• B. Tramadol
• C. Atorvastatin
• D. Metformin

Answer: (B)

Tramadol is known to potentially precipitate serotonin syndrome, especially when combined with selective serotonin reuptake inhibitors (SSRIs). This condition arises from an excess of serotonin in the central nervous system and can lead to symptoms such as confusion, agitation, muscle rigidity, and potentially life-threatening complications.

Tramadol, an opioid analgesic, has a dual mechanism of action; it not only works on the opioid receptors but also inhibits the reuptake of serotonin and norepinephrine. When combined with SSRIs, which increase serotonin levels, this can lead to a significantly heightened risk of serotonin syndrome due to the cumulative effect on serotonin levels.

In contrast, the other medications listed do not have a similar pharmacological relationship with SSRIs that would lead to an increased risk of serotonin syndrome. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) with no known interactions regarding serotonin levels. Atorvastatin is a cholesterol-lowering medication that does not affect serotonin pathways. Metformin is primarily used for managing type 2 diabetes and does not interact with serotonin receptors in a way that would lead to serotonin syndrome.

Thus, the combination of tramadol with SSRIs is particularly significant in the context of this question.