Patients w/ epilepsy, resp depression, anaphylactoid reactions; increased intracranial pressure/head trauma, opioid dependent patients, increased risk of liver toxicity, seizure & serotonin syndrome. Avoid abrupt withdrawal of therapy. May affect ability to drive or operate machinery. Renal & liver impairment. Co-administration w/ other tramadol or paracetamol-containing compd. Pregnancy & lactation. Childn <16 yr.