Tramadol + paracetamol - oral

Patient Medicine Information
Why do I need this medicine?
Tramadol and Paracetamol are combined in this medicine.

Tramadol + Paracetamol is used to relieve moderate to severe pain.
How do I take this medicine?
Take Tramadol + Paracetamol exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.

You may take this medicine with or without food.

This medicine is available as a conventional tablet, film-coated tablet or as an effervescent tablet.

If you are taking the film-coated tablet, swallow it whole with a glass of water. Do not divide, chew or crush the tablet.

If you are taking the effervescent tablet, dissolve the tablet in a glass of water before taking it.

Take Tramadol + Paracetamol for the shortest possible time and not longer than what your doctor has instructed you. You may stop taking this medicine when you have no more pain.
What should I do if I have forgotten to take this medicine?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.

DO NOT double a dose under any circumstances.
When should I not use this medicine?
Do not take this medicine if you ever had an allergic reaction (e.g. rashes, breathlessness, swollen eyes) to Tramadol or Paracetamol.

Alert your doctor if you have the following conditions:
  • severe lung problem known as respiratory depression (slow or ineffective breathing)
  • severe asthma
  • known or suspected blockage in the stomach or bowel e.g. paralytic ileus (bowel obstruction caused by slow movement or paralysis of the intestines)
  • uncontrolled epilepsy (fits or seizures)
  • have consumed a large amount of alcohol, sleeping pills, certain medicines that affect your mood and emotions, or strong painkillers
  • severe liver disease
as Tramadol + Paracetamol may not be suitable for you.

Do not give this medicine to children below 12 years old, in children below 18 years who have undergone surgery or removal of tonsils and/or adenoid glands, and adolescents between 12-18 years old who have risk factors for breathing problems, unless instructed to do so by the doctor.

Some genetic traits can affect the level of this medicine in the blood. Individuals who are ultrarapid metabolisers of CYP2D6 may experience enhanced effects of Tramadol + Paracetamol which also increases the risk of causing serious side effects. On the other hand, individuals who are poor metabolisers of CYP2D6 may have a lower response to this medicine. Though not routinely done, your doctor may advise you to undergo genetic testing to check if Tramadol + Paracetamol is best suited for you. If you know you have either of these gene types, inform your doctor.

Do not take Tramadol + Paracetamol if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine and tranylcypromine in the last 14 days.
What should I take note of while taking this medicine?
Inform your doctor if you have the following conditions:
  • heart problems e.g. recent heart attack
  • lung problems e.g. chronic obstructive pulmonary disease (long-term lung disease that causes airflow obstruction making it hard to breathe)
  • breathing problems during sleep
  • problems in the pancreas, gall bladder or bile duct
  • thyroid disease
  • disorder of the adrenal glands
  • enlarged prostate
  • kidney disease
  • mild to moderate liver disease
  • history of epilepsy (fits or seizures)
  • head injury
  • history of drug or alcohol abuse
  • delirium tremens (tremors, hallucination and disorientation caused by withdrawal from alcohol)
  • mental health problems e.g. depression, having thoughts of self-harm
  • G6PD deficiency (an inherited blood disorder that affects the red blood cell)
Let your doctor know if you are pregnant or breastfeeding.

Be sure to check with your doctor or pharmacist before giving Tramadol + Paracetamol to the elderly or debilitated patient (a person who is physically or mentally weak, usually due to illness or old age). Elderly people and debilitated patients may be more sensitive to the side effects.

If you are going to have certain laboratory tests (e.g. urine test for phencyclidine), inform your doctor that you are taking this medicine.

Avoid long-term use of any painkillers.

Do not take Tramadol + Paracetamol for any other purpose other than what your doctor has advised.

For as long as you are taking this medicine, you may need to regularly monitor your blood pressure and heart rate.
What side effects could I experience?
Tramadol + Paracetamol may cause dizziness or drowsiness. If affected, do not drive or take part in any activity in which you need to be alert.

This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.

Other side effects include any of the following: headache, nausea, vomiting, diarrhoea, dry mouth, constipation, stomach pain, indigestion, stomach wind, loss of appetite, sweating, difficulty sleeping, mood changes, confusion, and itching.

Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
  • rashes, difficulty of breathing, swelling of the face, lips, tongue or throat
  • severe drowsiness, slow or shallow breathing
  • fits or seizures
  • severe constipation
  • yellowing of the skin or eyes, dark coloured urine, tiredness, swelling in the legs and ankles
  • rashes with peeling of the skin or blistering of the lips, mouth or eyes accompanied by fever
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Can I take this with other medicines?
Do not take Tramadol + Paracetamol if you are currently taking or have taken medicines used to treat depression known as monoamine oxidase inhibitors (MAOIs) such as isocarboxazid, phenelzine and tranylcypromine in the last 14 days.

Inform your doctor and pharmacist if you are taking any of these medicines:
  • other strong painkillers e.g. buprenorphine, nalbuphine, pentazocine
  • medicines for epilepsy (fits or seizures) e.g. carbamazepine, phenytoin, phenobarbital
  • medicines for depression e.g. paroxetine, fluoxetine, amitriptyline, mirtazapine
  • medicines for nausea and vomiting e.g. ondansetron, metoclopramide
  • medicines for migraine e.g. sumatriptan
  • warfarin (blood-thinning medicine)
  • rifampicin (medicine to treat TB, infection known as tuberculosis)
  • quinidine (medicine for irregular heartbeat)
  • ketoconazole (medicine to treat fungal infection)
  • ritonavir (medicine for HIV infection)
  • St. John's wort (herbal medicine)
This list does not include all medicines that may interact with Tramadol + Paracetamol.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.
What special dietary instructions should I follow?
Avoid alcohol.
How should I store this medicine?
Store in a cool, dry place away from the reach of children.

Protect the effervescent tablets from moisture.

Medicines must not be used past the expiry date.
This information is independently developed by MIMS based on tramadol + paracetamol - oral and is provided for your reference only. It is not a replacement for and should only be used in conjunction with full consultation with a licensed healthcare professional, the information provided by your pharmacist and/or the manufacturer of the medication. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, we shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2023 MIMS. All rights reserved. Powered by
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