Generic Name: acetaminophen-tramadol, Oral tablet

Ultracet

All Brands

  • Ultracet
SECTION 1 of 4

Highlights for acetaminophen-tramadol

Oral tablet
1

Tramadol/acetaminophen is an oral tablet used to treat pain. It’s usually used for no longer than 5 days.

2

Side effects may include drowsiness, sleepiness, decreased concentration, and decreased coordination. Don’t drive or operate heavy machinery until you know how your body reacts to this medicine.

3

This medication contains acetaminophen, which can cause liver damage when used in high doses. Don’t take doses over 4,000 mg per day and don’t take other acetaminophen products while taking this drug.

4

This medication can be habit forming if you use it for a long time. You may also develop a tolerance to it, which makes it less effective.

IMPORTANT INFORMATION

FDA Warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

  • May cause liver damage. Liver failure can sometimes result in death or the need for a liver transplant. Most of the cases of liver injury happened when a person took more than 4,000 mg of acetaminophen per day, usually with more than one acetaminophen-containing product. Be careful not to combine this drug with other products containing acetaminophen.

Seizure warning

Seizures can happen when you take normal or higher doses of tramadol, which is one of the drugs in this combination. Your risk of seizures increases if you:

  • take doses that are higher than recommended
  • have a history of seizures
  • take tramadol with other medications, such as antidepressants, other opioids, and other drugs that affect brain function

May increase risk of suicide

The combination of tramadol and acetaminophen may increase the risk of suicide. Your risk may be higher if you have depression, are thinking about suicide, or have abused medications in the past.

Risk of serotonin syndrome

The combination of tramadol and acetaminophen may increase the risk of serotonin syndrome. This risk is possible if you have certain medical problems or are taking certain medications. Symptoms of serotonin syndrome may include:

  • agitation
  • increased heart rate or rapid heartbeat
  • changes in blood pressure
  • muscle weakness
  • fever
  • seizure

Drug Features

Tramadol/acetaminophen is a prescription controlled substance. It’s available as an oral tablet.

Tramadol/acetaminophen is a combination of two or more drugs in a single form. It’s important to know about all the drugs in the combination because they each may have unique traits.

Tramadol/acetaminophen is available in its generic form. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

Why It's Used

Tramadol/acetaminophen is used to treat moderate to severe acute pain for up to 5 days. It may work better for pain than using either tramadol or acetaminophen alone.

More Details

How It Works

This medication contains tramadol and acetaminophen. Tramadol belongs to a class of pain medicines called opioids (narcotics).

More Details

Why It's Used

Tramadol/acetaminophen is used to treat moderate to severe acute pain for up to 5 days. It may work better for pain than using either tramadol or acetaminophen alone.

This medicine may be used instead of full-dose acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioid combinations used for pain.

How It Works

This medication contains tramadol and acetaminophen. Tramadol belongs to a class of pain medicines called opioids (narcotics). Acetaminophen is an analgesic (pain reliever), but it’s not in the opioid or aspirin classes of drugs.

Tramadol treats pain by working on the central nervous system. It may also improve pain by working on norepinephrine and serotonin in your brain.

Acetaminophen treats pain and decreases fever.

SECTION 2 of 4

acetaminophen-tramadol Side Effects

Oral tablet

Most Common Side Effects

The most common side effects that occur with this medication when you take it for 5 days include:

  • feeling drowsy, sleepy, or tired

  • decreased concentration and coordination

  • constipation

  • dizziness

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • rash or itching, which can be symptoms of an allergic reaction to the drug. Allergic reactions to this drug can be life threatening.

  • liver damage and liver failure. Risk of liver damage is increased when this medicine is taken with alcohol or other drugs containing acetaminophen. Symptoms of liver damage can include:

    • dark urine
    • pale stools
    • nausea
    • vomiting
    • loss of appetite
    • stomach pain
    • yellowing of your skin or whites of your eyes
  • seizure. Your risk is higher if you take more than the dose that your doctor recommends. It’s also higher if you take certain drugs with this medication, such as antidepressants, other opioids, and other drugs that affect brain function.

  • increased risk of suicide, especially if you have depression, are thinking about suicide, or have abused medications in the past

  • serotonin syndrome, which can be fatal if left untreated. Symptoms may include:

    • agitation
    • hallucinations
    • coma
    • increased heart rate or rapid heartbeat
    • changes in blood pressure
    • fever
    • increased reflexes
    • lack of coordination
    • nausea
    • vomiting
    • diarrhea
    • seizures
  • decreased breathing

  • increased symptoms of depression, especially if you’re taking medications that help with sleep (sedative hypnotics), tranquilizers, muscle relaxers, or antidepressants

  • symptoms of withdrawal in people who have taken it for a long time or formed a habit to the drug. Symptoms may include:

    • restlessness
    • tearing eyes
    • runny nose
    • yawning
    • sweating
    • chills
    • muscle aches
    • wide pupils (mydriasis)
    • irritability
    • anxiousness
    • back or joint pain
    • weakness
    • stomach cramps
    • difficulty sleeping
    • nausea and vomiting
    • diarrhea
    • loss of appetite
    • increased blood pressure, heart rate, or breathing rate
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Tramadol/acetaminophen may cause drowsiness.

Mild side effects may disappear within a few days or after you complete 5 days of therapy. If side effects are more severe or don’t go away, talk to your doctor or pharmacist.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

acetaminophen-tramadol May Interact with Other Medications

Oral tablet

This medication can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions. 

Food Interactions

Taking this medication with food may make it take longer to relieve your pain.

Alcohol Interaction

Using alcohol while taking this drug can cause a sedative effect (slowed reflexes, poor judgment, sleepiness) that can be dangerous.

This medication can also work with alcohol to decrease breathing and cause liver damage. If you abuse alcohol while taking this drug, you have an increased risk for suicide.

Medications That Might Interact with This Drug

Drugs that cause drowsiness

Tramadol/acetaminophen may worsen the effects these medicines have on your central nervous system or breathing. 

These drugs include:

  • medicines for sleep
  • narcotics or opioids
  • pain medicines that act on the central nervous system
  • mind-altering (psychotropic) medicines

Acetaminophen

Using this medication with other drugs that contain acetaminophen can increase the risk of liver damage. Don’t take medications that list acetaminophen, or the abbreviation APAP, as an ingredient together with this drug.

Drugs that can cause seizures

Combining this medication with the following drugs increases your risk of seizures:

  • antidepressants (selective serotonin reuptake inhibitors [SSRIs], tricyclics, monoamine oxidase [MAO] inhibitors)
  • neuroleptics
  • other opioids (narcotics)
  • weight loss medications (anorectics)
  • promethazine
  • cyclobenzaprine
  • medicines that decrease the seizure threshold
  • naloxone, which may be used to treat overdose of tramadol/acetaminophen

Drugs that affect brain serotonin

Using this medication with drugs that work on serotonin in the brain may increase the risk of serotonin syndrome.

These may include:

  • antidepressants (SSRIs, serotonin-norepinephrine reuptake inhibitors [SNRIs], tricyclic antidepressant, MAO inhibitors, alpha2-adrenergic blockers)
  • migraine medications (triptans)
  • linezolid, an antibiotic
  • lithium
  • St. John’s wort, an herb

Drugs that affect liver function

Drugs that change how the liver breaks down (metabolizes) tramadol can increase the risk of serotonin syndrome.

Some examples of medications that shouldn’t be used with tramadol/acetaminophen include:

  • quinidine, used to regulate heart rate
  • fluoxetine, paroxetine, or amitriptyline (antidepressants, anti-anxiety)
  • ketoconazole or erythromycin, used to treat infections

Anesthetics

Using this medicine with anesthetic medicines and other opioids can decrease breathing.

Seizure medication
  • carbamazepine

Carbamazepine changes how your liver breaks down tramadol, which may decrease how well tramadol/acetaminophen treats your pain. Carbamazepine can be used to treat seizures. Using it with tramadol may hide that you have a seizure.

Heart medication
  • digoxin

Using tramadol with digoxin may increase the blood levels of digoxin.

Blood thinner (anticoagulant)
  • warfarin

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with kidney disorder

If you have a kidney disorder, your kidney function may be decreased. Your kidneys may remove tramadol from your body more slowly. This increases your risk of toxic side effects. You may need to take this medicine less often each day.

People with liver disease

This medication can increase your risk of liver failure if you have liver disease. You shouldn’t use this medication if you have liver disease.

People with seizures

This medication can increase your risk of seizure if you have seizures (epilepsy) or a history of seizures. This can happen at normal or higher doses. It can also increase your risk of getting a seizure if you:

  • have head trauma
  • have a problem with your metabolism
  • are undergoing alcohol or drug withdrawal
  • have an infection in your brain (central nervous system)

People with depression

This medication can increase your risk of suicide if you:

  • have depression
  • your mood is unstable
  • are considering or have attempted suicide
  • have misused tranquilizers, alcohol, or other medicines that act on the brain

If you’re depressed or thinking about suicide, it may be better to take a pain medication from a different drug class.

People with decreased breathing

This medication can decrease your breathing more if you have decreased breathing or are at risk for decreased breathing (respiratory depression). It may be better for you to take a pain medication from a different drug class.

People with brain pressure, head injury

If you have a head injury or increased pressure on your brain, this medication may:

  • worsen your breathing
  • increase pressure in your cerebrospinal fluid
  • cause your pupils to be small (miosis)
  • cause behavioral changes

These effects may hide or make it hard for your doctor to check on your head injury. They may also make it difficult to tell if your medical problems are getting worse or better.

People with history of addiction

This medication can increase the risk of overdose or death if you have an addiction disorder, or misuse or abuse opioids, narcotics, or other drugs.

People with stomach, abdomen problem

If you have a condition, such as severe constipation or obstruction, in which one of the symptoms is a pain in your abdomen, this medication may lessen that pain. That could make it more difficult for your doctor to diagnose your condition.

Pregnant women

This is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Tramadol is passed to a fetus during pregnancy. Long-term use of this medication during pregnancy may cause physical dependence and withdrawal symptoms in the baby at birth. Signs of withdrawal in a baby may include:

  • blotchy skin
  • diarrhea
  • excessive crying
  • irritability
  • fever
  • poor feeding
  • seizures
  • sleep problems
  • tremors
  • vomiting

Speak with your doctor if you’re pregnant or plan to become pregnant. This drug should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. It shouldn’t be used before or during labor.

Women who are nursing

These drugs pass through breast milk. This drug combination hasn’t been studied in babies. You shouldn’t use this medication before delivery to treat pain. The medicine shouldn’t be used after delivery to treat pain if you plan to breastfeed.

For Seniors

Use with caution if you’re older than 65 years. Your doses may need to be changed if you have liver, kidney, or heart problems, other diseases, or take medications that may interact with this medicine.

For Children

Keep this medication out of reach of children. A child who accidentally takes this medication or overdoses may experience decreased breathing, liver damage, and even death.

Call your local Poison Control Center if your child has accidentally taken this medicine, even if they feel well. The Center will help you decide if you need to go to the emergency room.

Allergies

Don’t take this medication if you’ve ever had an allergic reaction before to tramadol, acetaminophen, or the opioid class of medications. Taking it a second time after an allergic reaction could cause death.

This medication can cause a severe allergic reaction. Stop taking the medication right away and call your doctor if you have any of these symptoms after taking it:

  • trouble breathing
  • swelling of your throat or tongue
  • itching and hives
  • blistering, peeling, or red skin rash
  • vomiting

Though rare, some people have had serious allergic reactions that lead to death after their first tramadol dose.

SECTION 4 of 4

How to Take acetaminophen-tramadol (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What Are You Taking This Medication For?

Short-term treatment of acute pain

Brand: Ultracet

Form: Oral Tablet
Strengths: 3.75 mg tramadol/325 mg acetaminophen
Adult Dosage (ages 18 years and older)
  • The dose is 2 tablets taken every 4–6 hours as needed.
  • The maximum dose is 8 tablets per 24 hours.
  • The medication should not be taken for longer than 5 days.
Child Dosage (ages 16-17 years)
  • The dose is 2 tablets taken every 4–6 hours as needed.
  • The maximum dose is 8 tablets per 24 hours.
  • The medication should not be taken for longer than 5 days.
Child Dosage (ages 0-15 years)

Dosage for people younger than 16 years hasn’t been established.

Special Considerations

Reduced Kidney Function: If you have reduced kidney function, the time between your doses may be changed to every 12 hours. The number of tablets per day may also be lowered.

People Taking Central Nervous System Depressants, Alcohol: Your doses may need to be decreased if you’re using alcohol or the following central nervous system depressants:

  • opioids
  • anesthetic agents
  • narcotics
  • phenothiazines
  • tranquilizers
  • sedative hypnotics

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This medication comes with serious risks if you don't take it as prescribed by your doctor.

If You Take Too Much

You shouldn’t take more than eight tablets in a 24-hour period. This maximum amount may be less if you have certain health conditions. Taking too much of this medicine can increase your risk of decreased breathing, seizures, liver damage, and death.

If You Stop Taking It Suddenly

This medication can be habit forming if you take it for a long time. You could develop a physical dependence. If you stop suddenly after taking it for a long time, you may experience withdrawal symptoms. Symptoms of withdrawal may include:

  • restlessness
  • tearing eyes
  • runny nose
  • yawning
  • sweating
  • chills
  • muscle aches
  • wide pupils (mydriasis)
  • irritability
  • anxiousness
  • back or joint pain
  • weakness
  • stomach cramps
  • difficulty sleeping
  • nausea and vomiting
  • loss of appetite
  • diarrhea
  • increased blood pressure, heart rate, or breathing rate

Slowly decreasing doses and increasing the time between doses may lower your risk of withdrawal symptoms. 

How to Tell If the Drug Is Working

You may be able to tell that the drug is working if your pain decreases.

Tramadol/acetaminophen is a short-term drug treatment.

This drug is used short-term for up to 5 days. If you use tramadol for a long time, you may become tolerant to its effects. It may also be habit forming, which means it can cause mental or physical dependence. This can cause you to have withdrawal symptoms when you stop using it.

Store in temperatures from 59–86°F (15–30°C)

Make sure not to freeze the medication.

Keep this medication away from high temperatures. Don’t store it in the glove compartment of your car or in the sunlight.

Note: Keep your medications away from areas where they could get wet, such as bathrooms. Store them away from moisture and damp locations.

Travel

When traveling with your medication:

  • Always carry it with you or in your carry-on bag.
  • Airport X-ray machines can’t hurt this medication.
  • You may need to show your pharmacy’s preprinted label to identify the medication. Keep it in the original prescription-labeled box when traveling.

Clinical Monitoring

Your doctor may check for:

  • improvement in pain
  • pain tolerance
  • difficulties with breathing
  • seizures
  • depression
  • skin changes
  • changes in your pupils
  • stomach or intestinal problems (constipation, diarrhea)
  • symptoms of withdrawal when this medicine is being stopped
  • kidney function

This will help to make sure you take this medicine safely.

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for this medication.

What does the pill look like?

Showing - out of 19

Are There Any Alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Options may include full-dose acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and other opioid combinations.

If you have a higher risk of decreased breathing, are depressed or suicidal, or have a history of addiction, it may be better to take a pain medication from a different class of drugs.


Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on May 4, 2015

Send us your feedback

Thank you.

Your message has been sent.

We're sorry, an error occurred.

We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Read This Next

3 Ways to Do a Squat Thrust
3 Ways to Do a Squat Thrust
The Potential TBHQ Dangers
The Potential TBHQ Dangers
Colon Cleanse: What You Need to Know
Colon Cleanse: What You Need to Know
Advertisement
Advertisement
Advertisement