Tramadol with paracetamol

How it works

Tramadol is a weak mu-opioid agonist that also inhibits serotonin and noradrenaline reuptake, while paracetamol provides centrally mediated analgesia; the pairing combines a faster-acting and a longer-acting component.

Prescribing in practice

• Watch the total paracetamol load — account for paracetamol from all sources to avoid inadvertent overdose and hepatotoxicity, and be aware of tramadol's dependence and respiratory depression risk.
• Tramadol lowers the seizure threshold and can precipitate serotonin syndrome, so avoid co-prescribing with other serotonergic agents and in epilepsy.
• Reduce dose or extend the dosing interval in renal or hepatic impairment and in the elderly.

Monitoring

Monitor analgesic response, sedation, respiratory status and cumulative paracetamol intake from all preparations.

Counselling the patient

• Do not take any other paracetamol-containing product alongside this medicine.
• Avoid alcohol and report excessive drowsiness or difficulty breathing.
• Use only as directed and tell your prescriber if pain is not controlled.

Evidence & guidelines

The combination is supported by acute-pain randomised trials showing additive analgesia, with safety based on established paracetamol and opioid data.