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Ultracet Side Effects

Generic name: acetaminophen / tramadol

Medically reviewed by Drugs.com. Last updated on May 27, 2024.

Note: This document provides detailed information about Ultracet Side Effects associated with acetaminophen / tramadol. Some dosage forms listed on this page may not apply specifically to the brand name Ultracet.

Applies to acetaminophen / tramadol: oral tablet.

Important warnings This medicine can cause some serious health issues

Oral route (tablet)

Addiction, Abuse, and Misuse. TraMADol hydrochloride/acetaminophen exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death.

Assess each patient's risk prior to prescribing traMADol hydrochloride/acetaminophen, and monitor all patients regularly for the development of these behaviors or conditions.Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS)To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse and misuse, the Food and Drug Administration (FDA) has required a REMS for these products.

Under the requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers.

Healthcare providers are strongly encouraged to: complete a REMS-compliant education program, counsel patients and/or their caregivers, with every prescription, on safe use, serious risks, storage, and disposal of these products, emphasize to patients and their caregivers the importance of reading the Medication Guide every time it is provided by their pharmacists, and consider other tools to improve patient, household, and community safety.Life-threatening Respiratory Depression. Serious, life-threatening, or fatal respiratory depression may occur with use of traMADol hydrochloride/acetaminophen.

Monitor for respiratory depression, especially during initiation of traMADol hydrochloride/acetaminophen or following a dose increase.Accidental Ingestion. Accidental ingestion of even one dose of traMADol hydrochloride/acetaminophen, especially by children, can result in a fatal overdose of traMADol.Ultra-Rapid Metabolism of TraMADol and Other Risk Factors for Life-Threatening Respiratory Depression in Children. Life-threatening respiratory depression and death have occurred in children who received traMADol.

Most of the reported cases occurred following tonsillectomy and/or adenoidectomy, and many of the children had evidence of being an ultra-rapid metabolizer of codeine due to a CYP2D6 polymorphism.

TraMADol hydrochloride/acetaminophen tablets are contraindicated in children younger than 12 years of age and in children younger than 18 years of age following tonsillectomy and/or adenoidectomy.

Avoid the use of traMADol hydrochloride/acetaminophen tablets in adolescents 12 to 18 years of age who have other risk factors that may increase their sensitivity to the respiratory depressant effects of traMADol.Neonatal Opioid Withdrawal Syndrome. Prolonged use of traMADol hydrochloride/acetaminophen during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts.

If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.Interactions with Drugs Affecting Cytochrome P450 Isoenzymes. The effects of concomitant use or discontinuation of CYP3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with traMADol are complex.

Use of CYP3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with traMADol hydrochloride requires careful consideration of the effects on the parent drug, traMADol, and the active metabolite, M1.Hepatotoxicity. TraMADol hydrochloride/acetaminophen contains traMADol hydrochloride and acetaminophen.

Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death.

Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4000 mg per day, and often involve more than 1 acetaminophen-containing product.Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants. Concomitant use of opioids with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.

Reserve concomitant prescribing of traMADol hydrochloride and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate.

Limit dosages and durations to the minimum required.

Follow patients for signs and symptoms of respiratory depression and sedation.

Precautions

It is very important that your doctor check your or your child's progress at regular visits, especially within the first 24 to 72 hours of treatment, to make sure the medicine is working properly. Blood and urine tests may be needed to check for any unwanted effects.

Do not use this medicine if you are using or have used an MAO inhibitor (MAOI), such as isocarboxazid [Marplan®], linezolid [Zyvox®], phenelzine [Nardil®], selegiline [Eldepryl®], or tranylcypromine [Parnate®] within the past 14 days.

Using this medicine while you are pregnant may cause neonatal withdrawal syndrome in your newborn baby. Check with your doctor right away if your baby has an abnormal sleep pattern, diarrhea, a high-pitched cry, irritability, shakiness or tremors, weight loss, vomiting, or fails to gain weight. Tell your doctor right away if you think you are pregnant or if you plan to become pregnant while using this medicine.

Tramadol is highly metabolized in the body. Some people change tramadol to a stronger product (O-desmethyltramadol) more quickly than others. These individuals are called "ultra-rapid metabolizers of tramadol". Contact your doctor immediately if you experience extreme sleepiness, confusion, or shallow breathing. These symptoms may indicate that you are an "ultra-rapid metabolizer of tramadol." As a result, there is too much O-desmethyltramadol in the body and more side effects of O-desmethyltramadol than usual. Children may be especially sensitive to this effect (eg, serious breathing problems, death). Do not give this medicine to:

If a nursing mother is an ultra-rapid metabolizer of tramadol, it could lead to an overdose in the nursing baby and cause very serious side effects.

For nursing mothers using this medicine

Check with your doctor right away if you or your child have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

This medicine may cause serious allergic reactions, including anaphylaxis, angioedema, or certain skin conditions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis). These reactions can be life-threatening and require immediate medical attention. Call your doctor right away if you or your child have a rash, itching, blistering, peeling, or loosening of the skin, fever or chills, cough, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, trouble breathing or swallowing, unusual tiredness or weakness, or any swelling of your hands, face, mouth, or throat while you are using this medicine.

Check the labels of all nonprescription (over-the-counter [OTC]) or prescription medicines you now take. If any contain acetaminophen or tramadol, check with your doctor. Taking them together with this medicine may cause an overdose.

Before having any kind of surgery (including dental surgery) or emergency treatment, tell the doctor or dentist in charge that you or your child are taking this medicine. Serious side effects can occur if your doctor or dentist gives you certain medicines without knowing that you have been taking this medicine.

If you think you or someone else may have taken an overdose of this medicine, get emergency help at once. Your doctor may also give naloxone and other medicines to treat an overdose. Signs of an overdose include: dark urine, difficult or trouble breathing, irregular, fast or slow, or shallow breathing, nausea, vomiting, pain in the upper stomach, pale or blue lips, fingernails, or skin, pinpoint pupils of the eyes, or yellow eyes or skin.

Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). The use of alcohol or other medicines that affect the CNS with Ultracet® may worsen the side effects of this medicine, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

This medicine may cause sleep-related breathing problems (eg, sleep apnea, sleep-related hypoxemia). Your doctor may decrease your dose if you have sleep apnea (stop breathing for short periods during sleep) while using this medicine.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

Check with your doctor right away if you or your child have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.

This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Make sure your doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also, tell your doctor if you have any sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let your doctor know if you or anyone in your family has tried to commit suicide.

This medicine may cause some people to become dizzy, drowsy, or may cause trouble with thinking or controlling body movements, which may lead to falls, fractures or other injuries. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine may cause adrenal gland problems. Check with your doctor right away if you have darkening of the skin, diarrhea, dizziness, fainting, loss of appetite, mental depression, nausea, skin rash, unusual tiredness or weakness, or vomiting.

Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help. Also, lying down for a while may relieve dizziness or lightheadedness. If this problem continues or gets worse, check with your doctor right away.

This medicine may cause hyponatremia (low sodium levels in the blood). Check with your doctor right away if you have coma, confusion, decreased urine output, dizziness, fast or irregular heartbeat, headache, increased thirst, muscle pain or cramps, nausea or vomiting, swelling of the face, ankles, or hands, trouble breathing, or unusual tiredness or weakness.

Check with your doctor right away if you have anxiety, blurred vision, chills, cold sweats, coma, confusion, cool, pale skin, depression, dizziness, fast heartbeat, headache, increased hunger, nausea, nervousness, nightmares, seizures, shakiness, slurred speech, or unusual tiredness or weakness. These may be symptoms of hypoglycemia (low blood sugar level).

Do not change the dose or suddenly Stop taking acetaminophen / tramadol without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent worsening of your condition and reduce the possibility of withdrawal symptoms, such as anxiety, diarrhea, headache, nausea, shivering, sweating, tremors, or trouble sleeping.

Analgesics may cause dryness of the mouth. For temporary relief, use sugarless candy or gum, melted bits of ice in your mouth, or a saliva substitute. However, if dry mouth continues for more than 2 weeks, check with your dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Using too much of this medicine may cause infertility (unable to have children). Talk with your doctor before using this medicine if you plan to have children.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Common side effects of Ultracet

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 side effects

  • anxiety
  • belching
  • bloated or feeling of fullness
  • constipation
  • dry mouth
  • excess air or gas in the stomach or bowels
  • 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 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

Rare side effects

  • 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
  • delusions of persecution, mistrust, suspiciousness, or combativeness
  • difficulty in passing urine (dribbling)
  • false or unusual sense of well-being
  • 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
  • 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
  • vomiting of blood or material that looks like coffee grounds

Serious side effects of Ultracet

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:

Rare side effects

  • burning, itching, and redness of the skin
  • chest pain or tightness
  • 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
  • trouble breathing
  • unusual tiredness or weakness
  • vomiting

Incidence not known

  • agitation
  • anxiety
  • bigger, dilated, or enlarged pupils
  • blistering, peeling, or loosening of the skin
  • blurred vision
  • chills
  • cold sweats
  • coma
  • confusion
  • confusion as to time, place, or person
  • constricted, pinpoint, or small pupils
  • cool, pale skin
  • darkening of the skin
  • decreased urine output
  • depression
  • diarrhea
  • fainting
  • fever
  • hallucinations
  • headache
  • holding false beliefs that cannot be changed by fact
  • increased hunger
  • increased sensitivity of the eyes to light
  • increased thirst
  • irregular or slow heart rate
  • joint or muscle pain
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
  • loss of appetite
  • muscle cramps
  • nausea
  • nervousness
  • nightmares
  • noisy breathing
  • overactive reflexes
  • poor coordination
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • shakiness
  • shivering
  • slurred speech
  • sore throat
  • sores, ulcers, or white spots in the mouth or on the lips
  • sweating
  • swelling of the face, ankles, or hands
  • talking or acting with excitement you cannot control
  • trembling or shaking
  • twitching
  • unusual excitement, nervousness, or restlessness

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

Symptoms of overdose

For healthcare professionals

Applies to acetaminophen / tramadol: oral tablet.

General adverse events

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

Hepatic

Acetaminophen:

Tramadol:

Acetaminophen-Tramadol

Psychiatric

Tramadol:

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]

Acetaminophen-Tramadol

Gastrointestinal

Acetaminophen-Tramadol

Tramadol

Nervous system

Tramadol:

Acetaminophen-Tramadol

Dermatologic

Genitourinary

Cardiovascular

Acetaminophen-Tramadol:

Less than 1%: Aggravated hypertension, hypotension, chest pain

Tramadol:

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]

Hypersensitivity

Acetaminophen:

Tramadol:

Respiratory

Acetaminophen-Tramadol:

Tramadol:

Other

Hematologic

Acetaminophen:

Acetaminophen-Tramadol

Ocular

Metabolic

Severe hyponatremia and/or SIADH have been reported, most often in females over 65 years old, and within the first week of therapy.[Ref]

Endocrine

Opioids:

See also:

References

1. (2001) "Product Information. Ultracet (acetaminophen-tramadol)." Johnson and Johnson Medical Inc

2. Cerner Multum, Inc. "UK Summary of Product Characteristics."

3. Cerner Multum, Inc. "Australian Product Information."

Further information

Ultracet side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.