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A 35-year-old female asked:

I take ultram for fibro, zoloft and xanax (alprazolam) for panic anxiety disorder, and a ambien at night for sleep is this a safe combo?

4 doctor answers6 doctors weighed in
Dr. Shahid Rafique
Internal Medicine 44 years experience
No: Ultram and zoloft are generally not effective in fibromyalgia syndrome. Xanax (alprazolam) is generally not recommended for long term management of panic disorder. Ambien is safe and effective for sleep. There is no best combination. Your doctor will try various combinations and see what suits you best in terms of effectiveness and side effects.
Dr. Brian Writer
Psychiatry 16 years experience
Potentially: Ultram taken with zoloft can result in symptoms including gastrointestinal distress, confusion, changes in heart rate/blood pressure & temperature as well as involuntary movements ("myoclonus"). At the extreme, this condition (serotonin syndrome) can progress to death. Ultram, xanax (alprazolam) and Ambien taken together can result a dangerous level of sedation. Consider discussing risks with your doctor.
Dr. Douglas Bey
Psychiatry 57 years experience
Probably: Ultram & zoloft (sertraline) both raise serotonin & there are cautions about the possibility of a serotonin syndrome but i've seen many pts taling ssris & ultram with no problems.
Dr. Imad Khreim
Psychiatry 39 years experience
Xanax (alprazolam): I don't really recommend short acting benzos like xanax (alprazolam) for panic, they are associated with inter-dose withdrawal, faster tolerance and gradual elevation of baseline anxiety , discuss the issue with your psychiatrist, otherwise the combination is ok.

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Last updated Sep 28, 2016

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