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If you take an SSRI or SNRI for anxiety or depression, combining it with tramadol increases the risk of serotonin syndrome, a rare but serious condition

Poldip 2 mediates blood-brain barrier disruption in a model of sepsis-associated encephalopathy

But another reason to keep in mind other than cost, of course, and and cost containment, cost management is really because of some of the clinical aspects of these medications and the complexity of their use

doi:10.2337/db08-0958 315

Lancet Diabetes Endocrinol 8(3):239248