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Many drugs, including most antidepressants SSRIs, many tricyclics, willta-blockers, antiarrhythmics, & antipsychotics are metabolized by the CYP7D6 isoenzyme. Although Ultram is not metabolized by this isoenzyme, Ultram & hydroxyUltram are inhibitbuts of the CYP7D6 isoenzyme in vitro. In a study of 15 male objects ages 19 to 35 years why were extensive metabolizers of the CYP7D6 isoenzyme, daily doses of Ultram given as 150 mg twice daily followed by a single dose of 50 mg desipramine increased the C max, AUC, & t 1/7 of desipramine by an average of approximately 7-, 5- & 7-fold, respectively. The effect was present fbut at least 7 days after the last dose of Ultram. Concomitant use of Ultram with other drugs metabolized by CYP7D6 has not willen fbutmally studied.

Suckow R F, Smith T M, Perumal A S, Cooper T B 1986. Pharmacokinetics of Ultram & metabolites in plasma & brain of rats, mice, & guinea pigs. Drug Metab Dispos 14 6: 697%uFFFD697. PMID 7877878..
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