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Tramadol hydrochloride and Paracetamol combined with opioids, alcohol, or other illicit drugs can cause additive effects that can cause central nervous system depression. It can also reduce patients’ mental and physical abilities required to perform tasks such as operating machinery and driving. There may be carbon dioxide deposits in such patients, increased cerebrospinal fluid pressure, pupil narrowing, and eyemiosis, which may mask the presence and extent of cranial disease when taking the drug. 

This article surveys the pharmacological valuables, clinical effectiveness, and tolerability of  paracetamol  and tramadol for adults with moderate to severe pain. Tramadol, Paracetamol, Tramacet, Zaldiar, IX Primer, and Hummingbird can be given in fixed doses in combination with atypical opioids and indicated in the EU for symptomatic relief moderate to severe pain. Please take all necessary precautions when taking this medication in patients with elevated intracranial pressure or head injuries and evaluate their mental health status.

What are Tramadol Hydrochloride and Paracetamol, and how does it work?

Tramadol Hydrochloride and Paracetamol tablet are used to cure moderate to serious pain when your doctor suggests that a combination of both the drug is needed. 

Things you should know before consuming Tramadol Hydrochloride and Paracetamol.

Do not consume this medication if-

  • Have an allergy to this medicine
  • Acute alcohol
  • You are taking sleeping pills or any pain reliever pill.
  • Liver problems.

Taking this medicine with alcohol or other drugs can cause drowsiness and breathing problems, which can have serious side effects up to death. The risk of serious breathing problems is higher if you take medicine too early or if the dose is increased too quickly, or if you take the wrong dose or strength. This drug is not recommended for children with breathing problems because the symptoms of its toxicity may be worse for them. 

Warnings and precautions


  • The maximum dosage of 8 tablets of Tramadol hydrochloride/Paracetamol should not surpass in adults and adolescents 12 years and older.
  • In serious renal impairment, Tramadol hydrochloride and Paracetamol are not advised.
  • In patients with serious hepatic impairment, Tramadol hydrochloride/Paracetamol should not be used. 
  • In serious respiratory impairment, Tramadol hydrochloride and Paracetamol are not advised.
  • Tramadol is not favorable as a substitute in opioid-dependent victims. Even if it is an opioid agonist, tramadol cannot suppress morphine removal symptoms.


  • Concomitant use of Tramadol hydrochloride and Paracetamol and sedative medicines such as benzodiazepines or related drugs may result in sedation, respiratory depression, coma, and death.  
  • The patients should be followed similarly for signs and symptoms of respiratory depression and sedation. In this respect, it is strongly put forward to inform patients and their caregivers to be aware of these.
  • Symptoms of Tolerance, physical and psychological dependence may develop in the patient taking the medications. 
  • In patients who are prone to convulsive disorder, biliary tract disorders, in a state of shock, in an altered condition of consciousness for nonspecific reasons, with troubles affecting the respiratory center or the respiratory function, these medications should be used with proper caution.
  • The overdose of Paracetamol may cause hepatic toxicity to some patients. 
  • If a woman is pregnant or breastfeeding or may planning to have a baby, should get advice from the physician before taking this medicine. 

Drug interactions of Tramadol Hydrochloride and Paracetamol 

A total of 542 drugs interacts with tramadol, which includes-

  • 293 major
  • 246 moderate
  • 3 minor

Some of the drug names are- 

  • Ambien (zolpidem)
  • Aspirin Low Strength (aspirin)
  • Benadryl (diphenhydramine)
  • Celebrex (celecoxib)
  • Cymbalta (duloxetine)
  • Fish Oil (omega-3 polyunsaturated fatty acids)
  • Flexeril (cyclobenzaprine)
  • Lipitor (atorvastatin)
  • Lyrica (pregabalin)
  • Nexium (esomeprazole)
  • Norco (acetaminophen / hydrocodone)
  • Singulair (montelukast)
    A total of 116 drugs interacts with Paracetamol which includes-
  • 8 major
  • 73 moderates
  • 35 minor 

Some of the drug names are- 

  • amitriptyline
  • amlodipine
  • aspirin
  • atorvastatin
  • bisoprolol
  • ceftriaxone
  • codeine
  • diazepam
  • diclofenac
  • furosemide
  • gabapentin

How to take Tramadol Hydrochloride and Paracetamol together? 

It’s safe to take tramadol with Paracetamol, ibuprofen, or aspirin (aspirin is suitable for people who are 16 years and above). 
The starting dose of two tablets of Tramadol Hydrochloride and Paracetamol is recommended. Further doses can be taken as needed, not surpassing eight tablets (equivalent to 300 mg tramadol and 2600 mg paracetamol) per day. The dosing interim should not be less than 6 hours.

What are the possible side effects of Tramadol Hydrochloride and Paracetamol? 

Tramadol Hydrochloride-
Serious side effects include-

  • noisy breathing,
  • sighing,
  • shallow breathing,
  • breathing that stops during sleep,
  • slow heart rate,
  • weak pulse,
  • lightheadedness,
  • convulsions (seizure)
  • chest pain
  • upper stomach pain
  • loss of appetite
  • dark urine
  • jaundice nausea
  • vomiting
  • dizziness
  • worsening tiredness or weakness
  • agitation
  • hallucinations
  • fever
  • sweating
  • fast heart rate
  • muscle stiffness
  • twitching
  • loss of coordination 
  • diarrhea. 

Visit your doctor immediately if you have above mention side effects. 
Common side effects include dizziness, drowsiness, stomach pain, nausea, loss of appetite, constipation, and sweating. 
Rare side effects-

  • bloody or cloudy urine 
  • fever with or without chills  
  • pain in the lower back 
  • pinpoint red spots on the skin
  • skin rash, hives, or itching
  • a decrease in the amount of urine
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Symptoms of overdose are Diarrhea, excess sweating, loss of appetite, vomiting, stomach cramps and swelling, pain, or tenderness in the upper stomach area. 

How to store Tramadol Hydrochloride and Paracetamol

Both the medications are the remedy or average to severe pain. 

  • Keep the medications out of reach of children.
  • The medicine does not require any type of special storage conditions.

Tramadol liquid preparations will likely need to be refrigerated, but always follow the storage instructions on the product label.


Tramadol and Paracetamol in combination with tablets offered comparable analgesic efficacy and better safety profile in patients with post-operative pain after outpatient hand surgery compared to tramadol capsules. Postoperative pain management at home with tramadol, metamizole, and paracetaminol as a single substance after outpatient hand surgery proved insufficient in a controlled study in 40% of patients. Older patients (75 years old) in a placebo-controlled randomized study showed tramadol reduce intense pain after using as a treatment. a par-facetamol fixation dose combination (65.1%), which was important for complete pain relief (86% ).

In recent years, pain management has focused on the therapeutic potential of combining analgesic drugs with complementary pharmacokinetic and pharmacodynamic profiles to obtain greater efficacy and better safety profiles than alone. Fixed-dose combinations of painkillers that combine active agents with different mechanisms of action due to their broad analgesic spectrum and synergistic analgesic efficacy can improve the benefit-risk ratio and be beneficial.

References Accessed on July 19 2021

Rawal, Narinder et al. “Tramadol/paracetamol combination tablet for postoperative pain following ambulatory hand surgery: a double-blind, double-dummy, randomized, parallel-group trial.” Journal of pain research vol. 4 103-10. 8 Apr. 2011, doi:10.2147/JPR.S16760 Accessed on July 19 2021

Dhillon S. Tramadol/paracetamol fixed-dose combination: a review of its use in the management of moderate to severe pain. Clin Drug Investig. 2010;30(10):711-38. doi: 10.2165/11205830-000000000-00000. Erratum in: Clin Drug Investig. 2010;30(12):866. PMID: 20701403.
Accessed on July 19 2021 Accessed on July 19 2021