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Acetaminophen / tramadol Side Effects

For the Consumer

Applies to acetaminophen / tramadol: oral tablet

Along with its needed effects, acetaminophen/tramadol may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking acetaminophen / tramadol:

  • Burning, itching, and redness of the skin
  • chest pain
  • cough
  • difficulty with swallowing
  • dizziness
  • fast heartbeat
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • seizures
  • skin rash, hives, or itching skin
  • tightness in the chest
  • trouble breathing
  • unusual tiredness or weakness
  • vomiting
Incidence not known
  • Blistering, peeling, or loosening of the skin
  • chills
  • diarrhea
  • fainting
  • irregular or slow heart rate
  • joint or muscle pain
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • noisy breathing
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • sore throat
  • sores, ulcers, or white spots in the mouth or on the lips

Get emergency help immediately if any of the following symptoms of overdose occur while taking acetaminophen / tramadol:

Symptoms of overdose
  • Black, tarry stools
  • dark urine
  • difficulty with sleeping
  • disorientation
  • drowsiness to profound coma
  • fever
  • headache
  • irregular, fast or slow, or shallow breathing
  • light-colored stools
  • lightheadedness
  • loss of appetite
  • mood or other mental changes
  • nausea
  • pale or blue lips, fingernails, or skin
  • seeing, hearing, or feeling things that are not there
  • stomach pain
  • unpleasant breath odor
  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
  • vomiting of blood
  • yellow eyes or skin

Some side effects of acetaminophen / tramadol may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
  • Anxiety
  • belching
  • bloated or feeling of fullness
  • constipation
  • dry mouth
  • excess air or gas in the stomach or intestines
  • false or unusual sense of well-being
  • feeling of warmth
  • heartburn
  • increase in bowel movements
  • increased sweating
  • indigestion
  • loose stools
  • loss of strength or energy
  • muscle pain or weakness
  • numbness or tingling of the hands, legs, and feet
  • painful or difficult urination
  • redness of the face, neck, arms, and occasionally the upper chest
  • sleepiness or unusual drowsiness
  • soft stools
  • stomach discomfort
  • weight loss
  • Abnormal thinking
  • blurred vision
  • change in vision
  • clumsiness, unsteadiness, trembling, or problems with muscle control or coordination
  • cold sweats
  • continuing ringing, buzzing, or unexplained noise in the ears
  • crying
  • decrease in the frequency or amount of urination
  • decreased awareness or responsiveness
  • decreased interest in sexual intercourse
  • depression
  • difficulty in passing urine (dribbling)
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • dysphoria
  • euphoria
  • feeling of constant movement of self or surroundings
  • feeling unusually cold
  • headache, severe or continuing
  • increased muscle tone
  • involuntary muscle contractions
  • loss of memory
  • loss of sense of reality
  • loss of sexual ability, desire, drive, or performance
  • migraine headache
  • morbid dreaming
  • paranoia
  • pounding in the ears
  • problems with memory
  • quick to react or overreact emotionally
  • rapidly changing moods
  • sensation of spinning
  • severe stomach pain
  • shakiness and unsteady walk
  • shivering
  • swelling of the tongue
  • vomiting of blood or material that looks like coffee grounds

For Healthcare Professionals

Applies to acetaminophen / tramadol: oral tablet


The most common adverse reactions include nausea, somnolence, and dizziness.[Ref]


Uncommon (0.1% to 1%): Increased transaminases, abnormal hepatic function

Frequency not reported: Acute liver failure

Frequency not reported: Hepatitis, liver failure[Ref]


A psychic reaction with symptoms of nervousness, anxiety, agitation, tremor, spasticity, euphoria, emotional lability, and hallucinations has been reported with tramadol use. During clinical trials, tolerance development was mild and the reports of a withdrawal syndrome were rare. Symptoms of a withdrawal syndrome have included: panic attacks, severe anxiety, hallucinations, paresthesias, tinnitus and unusual CNS symptoms (i.e. confusion, delusions, personalization, derealization, and paranoia).[Ref]

Very common (10% or more): Insomnia
Common (1% to 10%): Altered mood (anxiety, nervousness, euphoric mood), sleep disorders
Uncommon (0.1% to 1%): Depression, hallucinations, nightmares, amnesia
Rare (less than 0.1%): Delirium, dependency
Frequency not reported: Depersonalization, paranoia
Postmarketing reports: Abuse

Frequency not reported: Psychic reactions including mood changes, withdrawal symptoms[Ref]


Very common (10% or more): Nausea (up to 18%), constipation (up to 11%)
Common (1% to 10%): Vomiting, dyspepsia, dry mouth, diarrhea, abdominal pain, flatulence
Uncommon (0.1% to 1%): Dysphagia, melena, tongue edema

Frequency not reported: Gastrointestinal bleeding[Ref]

Nervous system

Very common (10% or more): Dizziness (up to 15%), Somnolence (up to 12%), headache (up to 11%),
Common (1% to 10%): Tremor, confusion, paresthesia, hypoesthesia
Uncommon (0.1% to 1%): Migraine, hypertonia, stupor, involuntary muscle contractions
Rare (less than 0.1%): Seizures, ataxia, speech disorders

Frequency not reported: Serotonin syndrome[Ref]


Common (1% to 10%): Sweating, pruritus, rash
Uncommon (0.11% to 1%): dermal reactions such as rash and urticaria[Ref]


Uncommon (0.1% to 1%): Albuminuria, micturition disorders (dysuria and urinary retention)
Frequency not reported: Impotence[Ref]


Uncommon: Hypertension, palpitations, tachycardia, arrhythmia
Less than 1%: Aggravated hypertension, hypotension, chest pain

Frequency not reported: Postural hypotension, bradycardia, syncope, vasodilation, myocardial ischemia
Postmarketing reports: QT prolongation/torsade de pointes[Ref]

Postmarketing reports of QT prolongation and/or torsade de pointes have been received for tramadol-containing products. In many cases, patients were taking another drug associated with QT prolongation, had risk factors for QT prolongation such as hypokalemia, or in the overdose setting.[Ref]


Frequency not reported: Allergic reactions (primarily skin rash)

Rare (less than 0.1%): Anaphylaxis, allergic reactions such as dyspnea, bronchospasm, wheezing, urticarial and Stevens-Johnson syndrome/TENS[Ref]


Uncommon (0.1% to 1%): Dyspnea

Frequency not reported: Asthma aggravated[Ref]


Common (1% to 10%): Asthenia, fatigue, hot flushes
Uncommon (0.1% to 1%): Tinnitus, shivers[Ref]


Frequency not reported: Anemia

Frequency not reported: Blood dyscrasias including thrombocytopenia and agranulocytosis[Ref]


Uncommon (0.1% to 1%): Abnormal vision
Rare (less than 0.1%): Blurred vision, mydriasis, miosis[Ref]


Common (1% to 10%): Anorexia
Frequency not reported: Hypoglycemia, decreased weight[Ref]


Common (1% to 10%): Prostatic disorder

Postmarketing reports: Adrenal insufficiency; androgen deficiency[Ref]


1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

2. Cerner Multum, Inc. "Australian Product Information." O 0

3. "Product Information. Ultracet (acetaminophen-tramadol)" Johnson and Johnson Medical Inc, Arlington, TX.

Some side effects of acetaminophen / tramadol may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. 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 substances you are taking, check with your doctor, nurse, or pharmacist.