title: Two separate dose-dependent effects of paroxetine: mydriasis and inhibition of tramadol's O-demethylation via CYP2D6.
abstract: OBJECTIVE
  To investigate paroxetine's putative dose-dependent impact on pupil reaction and inhibition of the O-demethylation of tramadol.
  
  
  METHODS
  Twelve healthy CYP2D6 extensive metabolizers participated in this double-blinded randomized five-way placebo controlled cross-over study; they received placebo, 10, 20, 30, and 50 mg paroxetine as single oral doses at bedtime. Next morning the pupil was measured followed by oral intake of 50 mg of tramadol, and urine was collected for 8 h. Three hours after ingestion of tramadol a second measurement of the pupil was performed. Enantioselective urine concentrations of (+/-)-tramadol and (+/-)-O-desmethyltramadol (M1) were determined.
  
  
  RESULTS
  With placebo, the median maximum pupil diameter was 6.43 mm (range 5.45-7.75 mm) before tramadol and 6.22 mm (4.35-7.65 mm) after 50 mg of tramadol (P = 0.4935). Paroxetine resulted in a statistically significant, dose-dependent dilatation of the pupil with a geometric mean difference of 1.17 (95% CI 1.10-1.24) after ingestion of 50 mg paroxetine (P < 0.001). Likewise, a reduction in the relative constriction amplitude with a geometric mean difference of 0.81 (95% CI 0.71-0.92) (P < 0.001) was seen. A dose-dependent inhibition of the metabolism of tramadol by an increase in the two urinary metabolic ratios (+)-tramadol / (+)-M1 [geometric mean difference 9.09, 95% CI 5.60-14.73 (P < 0.001)] and (-)-M1 / (+)-M1 [geometric mean difference 2.84, 95% CI 2.15-3.77 (P < 0.001)] was also observed.
  
  
  CONCLUSIONS
  Paroxetine is a dose-dependent dilator of the pupil and as expected a dose-dependent inhibitor of (+)-tramadol's O-demethylation.
authors.affiliation: Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, Odense, Denmark.
authors.forename: Anette Green
authors.initials: AG
authors.lastname: Nielsen
authors.forename: Rasmus Steen
authors.initials: RS
authors.lastname: Pedersen
authors.forename: Lene
authors.initials: L
authors.lastname: Noehr-Jensen
authors.forename: Per
authors.initials: P
authors.lastname: Damkier
authors.forename: Kim
authors.initials: K
authors.lastname: Brosen
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000494:pharmacology*; D065690:Cytochrome P-450 CYP2D6 Inhibitors; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D017374:Paroxetine / Q000008:administration & dosage / Q000494:pharmacology*; D011680:Pupil / Q000187:drug effects*; D014147:Tramadol / Q000031:analogs & derivatives / Q000493:pharmacokinetics* / Q000652:urine
chemical_list: D000701:Analgesics, Opioid; D018687:Antidepressive Agents, Second-Generation; D065690:Cytochrome P-450 CYP2D6 Inhibitors; C080580:O-demethyltramadol; D014147:Tramadol; D017374:Paroxetine