Action
Tramadol
- opioid agonist at mu receptors
- Alters perception of pain in brain
- Inhibits reuptake of norepinephrine, Serotonin
- Enhances serotonin release
Paracetamol
- Analgesic, Antipyresis, Weak anti inflammatory
- Inhibition of prostaglandin synthesis in CNS
Adult Dose
Moderate to Severe pain
- Dose: 1-2 tab 6 hrly
- Max: 8 tab/day
- Max duration: 5 day
Child Dose
Not recommended in child under 18 yrs of age
Special Condition
- Renal impairment
- Hepatic Impairment
- Lactation
- Pregnancy
Contraindication
- Hypersensitivity
- Acute intoxication with alcohol
- Hypnotic drugs
- Centrally acting analgesics
- Opioids or psychotropic drugs
- Severe hepatic impairment
- Uncontrolled epilepsy
- With MAOI (before and after 14 days)
Side Effect
- Postural hypotension
- Resp depression
- Hepatoxicity
- Stevens-Johnson syndrome
- Toxic epidermal necrosis
- Bradycardia
- Collapse
- Allergic reactions with rep symptoms
- Bronchospasm
- Wheezing
- Angioneurotic oedema
- Changes in appetite
- Motor Weakness
- Changes in mood
- Activity
- Cognitive and sensorial capacity
- Exacerbation of asthma
- Withdrawal symptoms
- Skin rash
- Blood dyscrasias
- Hypoprothrombinemia
- Potentially Fatal
Precaution
- Patient with epilepsy controlled by treatment, risk of seizure, cranial trauma, biliary tract disorder, altered state of consciousness for unknown reasons, problems affecting the resp center or resp function, increased intracranial pressure, suicidal tendency or patients in a state of shock.
- Not a suitable substitute in opioid dependent patients
- May cause withdrawal symptoms, dependent patients
- Severe renal impairment
- Pregnancy and Lactation
- Patient counselling may impair ability to drive or operate machinery
- Monitoring parameters monitor pain relief rate, BP and Pulse rate, Signs of tolerance, abuse or suicidal ideation.
Interaction
- Increased risk of seizures and serotonin syndrome with SSRIs, SNRIs, TCAs and 5HT agonists
- Increased CNS depression with barbiturates, benzodiazepines, other anxiolytics, hypnotics, sedative antidepressants, sedative antihistamines, neuroleptics, centrally acting antihypertensive drugs, thalidomide and baclofen.
- Decreased analgesic efficacy with ondansetron
- Increased INR with warfarin
- Potentially fatal
- Increased risk of seizure and serotonin syndrome with MAOIs.
