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acetaminophen and tramadol


Generic Name: acetaminophen and tramadol (a SEET a MIN o fen and TRAM a dol)
Brand Name: Ultracet

What is acetaminophen and tramadol?

Tramadol is a narcotic-like pain reliever. Acetaminophen is a less potent pain reliever that increases the effects of tramadol.

Acetaminophen and tramadol is a combination medicine used to treat moderate to severe pain.

Acetaminophen and tramadol may also be used for purposes not listed in this medication guide.

What is the most important information I should know about acetaminophen and tramadol?

You should not use this medicine if you have recently used alcohol, sedatives, tranquilizers, or other narcotic medications.

Do not take more than your recommended dose. An acetaminophen overdose can damage your liver or cause death. Call your doctor at once if you have nausea, pain in your upper stomach, itching, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of your skin or eyes).

In rare cases, acetaminophen may cause a severe skin reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling.

Acetaminophen and tramadol may be habit-forming and should be used only by the person it was prescribed for. Never share this medication with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

What should I discuss with my healthcare provider before taking acetaminophen and tramadol?

You should not use this if you are allergic to acetaminophen (Tylenol) or tramadol (Ultram), or if you have recently used alcohol, sedatives, tranquilizers, or other narcotic medications.

Seizures have occurred in some people taking acetaminophen and tramadol. Your risk of a seizure may be higher if you have any of these conditions:

  • a history of drug or alcohol addiction;

  • a history of epilepsy or other seizure disorder;

  • a history of head injury;

  • a metabolic disorder;

  • an infection of your brain or spinal cord, such as meningitis or encephalitis;

  • if you are also taking an antidepressant, mood stabilizer, or another narcotic pain medicine; or

  • if you have taken an MAO inhibitor (isocarboxazid, linezolid, methylene blue injections, phenelzine, rasagiline, selegiline, tranylcypromine) within the past 14 days.

Some medicines can interact with tramadol and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.

To make sure acetaminophen and tramadol is safe for you, tell your doctor if you have:

  • liver disease, cirrhosis, a history of alcoholism, or if you drink more than 3 alcoholic beverages per day;

  • kidney disease;

  • asthma or other breathing disorder;

  • a stomach disorder; or

  • a history of depression, mental illness, or suicide attempt.

It is not known whether the combination of acetaminophen and tramadol is harmful to an unborn baby. Tramadol alone may have caused serious or fatal side effects in newborns of mothers who used the medication during pregnancy or labor. Tell your doctor if you are pregnant or plan to become pregnant during treatment with acetaminophen and tramadol.

Acetaminophen and tramadol can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

How should I take acetaminophen and tramadol?

Follow all directions on your prescription label. Never take this medicine in larger amounts, or for longer than prescribed. An overdose can damage your liver or cause death. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Acetaminophen and tramadol may be habit forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

Acetaminophen and tramadol can be taken with or without food, but take it the same way each time.

The maximum amount of acetaminophen and tramadol is 2 tablets per dose, or 8 tablets per day. Do not take this medicine for longer than 5 days in a row.

Do not stop using this medicine suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using acetaminophen and tramadol.

Store at room temperature away from moisture and heat.

Keep track of the amount of medicine used from each new bottle. Acetaminophen and tramadol is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I miss a dose?

Since acetaminophen and tramadol is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An acetaminophen and tramadol overdose can be fatal.

The first signs of an acetaminophen overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in your upper stomach, dark urine, and yellowing of your skin or the whites of your eyes.

Overdose symptoms may also include shallow breathing, slow heartbeat, extreme weakness, cold or clammy skin, feeling light-headed, fainting, seizure, or coma.

What should I avoid while taking acetaminophen and tramadol?

Do not drink alcohol while you are taking acetaminophen and tramadol. Alcohol may cause a dangerous decrease in your breathing when used together with acetaminophen and tramadol. Alcohol may also increase your risk of liver damage while taking acetaminophen.

Acetaminophen and tramadol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP.

Acetaminophen and tramadol side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

In rare cases, acetaminophen may cause a severe skin reaction that can be fatal. This could occur even if you have taken acetaminophen in the past and had no reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. If you have this type of reaction, you should never again take any medicine that contains acetaminophen.

Stop using acetaminophen and tramadol and call your doctor at once if you have:

  • shallow breathing, slow heartbeat, weak pulse;

  • a light-headed feeling, like you might pass out;

  • confusion, agitation, hallucinations, unusual thoughts or behavior;

  • fever, fast heart rate, overactive reflexes, vomiting, diarrhea, loss of coordination;

  • seizure (convulsions);

  • easy bruising or bleeding;

  • infertility, missed menstrual periods;

  • impotence, sexual problems, loss of interest in sex;

  • liver problems--nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

  • low cortisol levels-- nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common side effects may include:

  • dizziness, drowsiness, weakness, tired feeling;

  • stomach pain, constipation, loss of appetite;

  • dry mouth, blurred vision;

  • feeling nervous or anxious;

  • sweating, itching; or

  • sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Acetaminophen and tramadol dosing information

Usual Adult Dose for Pain:

Usual dose: 2 tablets every 4 to 6 hours as needed for pain
Maximum dose: 8 tablets per day
Maximum duration: 5 days

-Each tablet contains Tramadol 37.5 mg and Acetaminophen 325 mg. Maximum daily doses are Tramadol: 300 mg per day and Acetaminophen 2600 mg per day.
-Use of more than 1 product at time containing acetaminophen is not recommended.

Use: For the short-term management of acute pain; use should be limited to 5 days or less.

Usual Geriatric Dose for Pain:

Dose selection should be cautious due to potential for greater sensitivity to adverse events.

What other drugs will affect acetaminophen and tramadol?

Some medicines can cause unwanted or dangerous effects when used with acetaminophen and tramadol. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.

Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking acetaminophen and tramadol with a sleeping pill, muscle relaxer, other narcotic pain medicine, or medicine for anxiety, depression, or seizures.

Other drugs may interact with acetaminophen and tramadol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about acetaminophen and tramadol.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 7.03.

Last reviewed: March 28, 2016
Date modified: October 14, 2016