Opioid + paracetamol combination
Tramadol with paracetamol
Brand names: Tramacet, Maxitram
Adult dose
Dose: 1-2 tabs (37.5/325mg) PO every 4-6h (max 8 tabs/day)
Route: PO
Frequency: q4-6h
Clinical pearls
- Moderate pain; combination dose limited by paracetamol
- Watch for paracetamol overdose if other paracetamol products taken
Contraindications
- Concurrent MAOI
- Acute alcohol/opioid intoxication
- Uncontrolled epilepsy
- Severe hepatic impairment
Side effects
- Nausea
- Constipation
- Dizziness
- Hepatotoxicity (paracetamol)
- Seizures
- Dependence
Interactions
- MAOIs
- SSRIs
- Warfarin (paracetamol potentiation at high dose)
- CYP2D6 inhibitors
Monitoring
- Pain
- LFTs
Reference: BNF; NICE; FPM; https://bnf.nice.org.uk/drugs/tramadol-with-paracetamol/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Morphine Milligram Equivalents (MME) Calculator · Pain / Opioids
- Opioid Conversion / Equianalgesic Guide · Pain Management
- Rumack-Matthew Nomogram · Toxicology
- Numeric Rating Scale (NRS) Pain Assessment and Management · Pain Management
- King's College Criteria for Acute Liver Failure · Prognosis
- Kings College Criteria for Paracetamol Toxicity · Hepatology
Pathways
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109
- Acute Chest Pain · NICE CG95; ESC 2023 ACS Guidelines