tramadol / acetaminophen
Ultracet (tramadol / acetaminophen) is a combination pain medication that should only be used for pain that hasn't responded to other alternatives. It's only used for short-term pain, so it should be taken for no more than 5 days.
What is Ultracet (tramadol / acetaminophen)?
What is Ultracet (tramadol / acetaminophen) used for?
Acute (short-term) pain
How Ultracet (tramadol / acetaminophen) works
Ultracet (tramadol / acetaminophen) is a combination pain medication that contains tramadol (an opioid) and acetaminophen (an analgesic). It's unclear how tramadol works in the treatment of pain, but it's thought that its activities with the mu-opioid receptor and effects on serotonin and norepinephrine levels in the brain may lower your perception (awareness) of pain. Acetaminophen relieves pain and lowers fevers by stopping the production of certain chemicals in the brain that cause both pain and fever.
Drug Facts
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What are the risks and warnings for Ultracet (tramadol / acetaminophen)?
Ultracet (tramadol / acetaminophen) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Addiction, abuse, and misuse
Risk factors: Mental health conditions (e.g., depression) | History of or family history of substance abuse
Ultracet (tramadol / acetaminophen) has a risk of addiction, abuse, and misuse. Your body can develop tolerance to Ultracet (tramadol / acetaminophen), which means that more medication is needed to treat the same pain. You may become physically dependent on Ultracet (tramadol / acetaminophen) if you have been using it continuously, which means that you'll feel withdrawal symptoms if you stop taking it suddenly. Take only the prescribed dose. People with a history of substance abuse shouldn't take Ultracet (tramadol / acetaminophen) if an alternative medication is available.
Medication education programs
Since Ultracet (tramadol / acetaminophen) can cause potentially life-threatening and deadly side effects, the manufacturers are required to provide healthcare providers with the resources to prescribe this medication properly and safely. Your provider or pharmacist will discuss the risks and benefits with taking Ultracet (tramadol / acetaminophen) before you start the medication.
Life-threatening breathing problems
Risk factors: People age 65 or older | People who are severely ill | Lung disease
Ultracet (tramadol / acetaminophen) can cause irregular or slowed breathing that can put you in a coma and can even cause death. Don't take more than what your provider prescribed to you. Always check with your provider before starting any new medications or supplements. Make sure to take special precautions to store this medication in a safe place away from the reach of children. If a child accidentally uses this medication, they may overdose, develop breathing problems, and potentially have a deadly outcome. If this happens, call the poison control center right away at 1-800-222-1222.
Slowed breathing in children
Risk factors: Children with obstructive sleep apnea or lung disease | Children who are obese | Adenoid or tonsil surgery in children
Some people have a gene that causes them to process Ultracet (tramadol / acetaminophen) too fast. Children who have this gene can be especially sensitive to this quick metabolism (breakdown) of Ultracet (tramadol / acetaminophen), which can result in slowed breathing and even death. Deadly breathing problems have also occurred in children who received Ultracet (tramadol / acetaminophen) following removal of their tonsils or adenoids. This medication shouldn't be used in children younger than 12 years old or children between 12 and 18 years old who are at high risk for breathing problems.
Withdrawal in infants
Risk factors: Long-term use of Ultracet (tramadol / acetaminophen) during pregnancy
There is a high risk that your newborn baby could develop withdrawal symptoms if you've been using Ultracet (tramadol / acetaminophen) for a long period of time during pregnancy. These withdrawal symptoms can be deadly for infants. If you're pregnant or think you may be pregnant, discuss with your provider about all of the risks that are associated with this medication before starting it.
Dangerous interactions with other medications and alcohol
Ultracet (tramadol / acetaminophen) can interact with other medications, which can change how it affects your body and pain overall. Some medications can increase the levels of Ultracet (tramadol / acetaminophen) in your body and cause potentially deadly respiratory depression (slowed breathing). Other medications can lower the levels of Ultracet (tramadol / acetaminophen) in your body and lead to poor control of your pain. Some examples of medications that might interact with Ultracet (tramadol / acetaminophen) include, certain anbiotics, antifungals, and medications used for anxiety or depression. It's also very important to avoid alcohol while on this medication, because the combination can lead to serious side effects such as slowed breathing, low blood pressure, and extreme sedation. While taking Ultracet (tramadol / acetaminophen), don't start any new prescription or over-the-counter medications until confirming with your provider or pharmacist that it is safe to do so.
Liver damage
Risk factors: Taking more than 4 grams of acetaminophen a day | Taking multiple products containing acetominophen
Acetaminophen, which is in Ultracet (tramadol / acetaminophen), has been associated with liver failure. You are at higher risk if you're taking more than one product containing acetaminophen and taking more than 4 grams a day. If you suspect that you took more than this maximum daily dose, get medical help right away, even if you're feeling okay.
Increased serotonin levels (serotonin syndrome)
Risk factors: Using other medications that affect serotonin | Using monoamine oxidase inhibitors (MAOIs) within 14 days of Ultracet (tramadol / acetaminophen)
Serotonin syndrome is a rare, but potentially life-threatening condition caused by higher levels of serotonin in the brain. Your risk goes up if you use Ultracet (tramadol / acetaminophen) with other medications that affect serotonin, such as antidepressants, lithium, triptans, and St. John's wort. Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion. If you notice any of these symptoms, get medical attention right away.
Seizures
Risk factors: History of seizures | Taking with antidepressants, medications that can cause seizures, or other opioids
Ultracet (tramadol / acetaminophen) can raise your risk of seizures. If you have a history of seizures, taking medications that can cause seizures, or have risk factors for getting seizures, let your provider know so that they can monitor for new or worsening of symptoms.
Suicide risk
Ultracet (tramadol / acetaminophen) shouldn't be given to people who have a history of substance or alcohol abuse, or to people who are depressed or suicidal, because this medication can worsen those problems.
Adrenal problems
Risk factors: Using Ultracet (tramadol / acetaminophen) for more than a month
Ultracet (tramadol / acetaminophen) can cause your adrenal glands to not make the right amount of hormones for your body to function properly. If you experience nausea, vomiting, loss of appetite, fatigue, weakness, dizziness, and low blood pressure while taking this medication, let your provider know. Your provider may need to do a proper exam to rule out adrenal problems.
Low blood pressure
Ultracet (tramadol / acetaminophen) can cause a sudden drop in your blood pressure. You may feel dizzy and lightheaded. If you're sensitive to low blood pressures, change positions slowly, such as going from sitting to standing. If you always get low blood pressure symptoms, you may need to try a different pain medication.
Head or brain injuries
People who have brain or head injuries are at higher risk of developing extreme sedation and breathing problems while taking Ultracet (tramadol / acetaminophen). Let your provider know about all of your medical conditions before starting this medication.
Digestive tract blockage
If you have certain stomach conditions or digestive tract blockage, don't use Ultracet (tramadol / acetaminophen), because it can worsen your problems. Let your provider know if you experience stomach pain, feeling of fullness in your stomach, or extreme constipation while taking this medication.
Withdrawal symptoms
*Risk factors: Abrupt discontinuation of
Ultracet (tramadol / acetaminophen)*
Ultracet (tramadol / acetaminophen) shouldn't be used for more than 5 days. If you are instructed by your provider to take this medication for longer than 5 days, don't stop taking it all of a sudden on your own. Doing so can cause withdrawal symptoms and the return of your pain. Withdrawal symptoms can include restlessness, yawning, chills, nausea, vomiting, diarrhea, and increased irritability. Your provider will work with your to lower your dose slowly to avoid side effects.
Driving and operating machinery
Ultracet (tramadol / acetaminophen) can affect your abilities to think, focus, and react. Be careful driving, operating machinery, or doing any dangerous activities until you know how this medication affects you.
Serious allergic reactions
Ultracet (tramadol / acetaminophen) can cause serious and potentially life-threatening allergic reactions. If you experience hives, swelling of your face, throat, or tongue, or difficulty breathing while taking this medication, get medical help right away. You will need to stop taking Ultracet (tramadol / acetaminophen) and switch to a different medication.
Serious skin reactions
In some rare cases, Ultracet (tramadol / acetaminophen) can cause serious skin reactions. If you notice a rash, blisters, or skin peeling after taking Ultracet (tramadol / acetaminophen), you should stop using it right away and get medical attention as quickly as possible.
What are the side effects of Ultracet (tramadol / acetaminophen)?
Common Side Effects
- Constipation (6%)
- Sleepiness (6%)
- Increased sweating (4%)
- Diarrhea (3%)
- Nausea (3%)
- Poor appetite (3%)
- Dizziness (3%)
Other Side Effects
- Dry mouth
- Stomach pain
- Indigestion or upset stomach
- Weakness
- Fatigue
- Headache
- Anxiety
- Shakiness
- Trouble sleeping
- Itching
- Prostate problems
Serious Side Effects
- __Trouble breathing __
- Fast heartbeat
- Chest pain
- Swelling of your face, tongue or throat
- Extreme sleepiness
- Increased irritability
- Increased body temperature
- Trouble walking
- Stiff muscles
- Mental changes, such as confusion
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Burning, itching, and redness of the skin
chest pain or tightness
difficulty with swallowing
dizziness
fast heartbeat
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
seizures
skin rash, hives, or itching skin
trouble breathing
unusual tiredness or weakness
vomiting
Incidence not known
Agitation
bigger, dilated, or enlarged pupils
blistering, peeling, or loosening of the skin
chills
confusion
confusion as to time, place, or person
constricted, pinpoint, or small pupils
darkening of the skin
fainting
hallucinations
holding false beliefs that cannot be changed by fact
increased sensitivity of the eyes to light
irregular or slow heart rate
joint or muscle pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
loss of appetite
noisy breathing
overactive reflexes
poor coordination
red skin lesions, often with a purple center
red, irritated eyes
shivering
sores, ulcers, or white spots in the mouth or on the lips
sweating
talking or acting with excitement you cannot control
trembling or shaking
twitching
unusual excitement, nervousness, or restlessness
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Black, tarry stools
dark urine
disorientation
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness to profound coma
headache
irregular, fast or slow, or shallow breathing
lightheadedness
loss of appetite
mood or other mental changes
pale or blue lips, fingernails, or skin
seeing, hearing, or feeling things that are not there
stomach pain
trouble sleeping
unpleasant breath odor
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
vomiting of blood
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
belching
bloated or feeling of fullness
excess air or gas in the stomach or bowels
false or unusual sense of well-being
feeling of warmth
increase in bowel movements
increased sweating
indigestion
loose stools
loss of strength or energy
muscle pain or weakness
numbness or tingling of the hands, legs, and feet
painful or difficult urination
redness of the face, neck, arms, and occasionally the upper chest
sleepiness or unusual drowsiness
soft stools
stomach discomfort
Rare
Abnormal thinking
blurred vision
change in vision
clumsiness, unsteadiness, trembling, or problems with muscle control or coordination
cold sweats
continuing ringing, buzzing, or unexplained noise in the ears
crying
decrease in the frequency or amount of urination
decreased awareness or responsiveness
decreased interest in sexual intercourse
delusions of persecution, mistrust, suspiciousness, or combativeness
difficulty in passing urine (dribbling)
false or unusual sense of well-being
feeling of constant movement of self or surroundings
feeling unusually cold
headache, severe or continuing
increased muscle tone
involuntary muscle contractions
loss of memory
loss of sense of reality
loss of sexual ability, desire, drive, or performance
migraine headache
morbid dreaming
pounding in the ears
problems with memory
quick to react or overreact emotionally
rapidly changing moods
sensation of spinning
severe stomach pain
shakiness and unsteady walk
shivering
vomiting of blood or material that looks like coffee grounds
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Ultracet (tramadol / acetaminophen)
Pros
Two pain medications conveniently combined into one tablet to provide pain relief
Has a lower chance of causing breathing problems compared to stronger opioid pain medications
Doesn't cause as much constipation compared to other opioid pain medications
Pain relief kicks in faster than using tramadol (Ultram) alone
Pain relief lasts longer than using acetaminophen (Tylenol) alone
Generic available, making it more affordable
Cons
Only used for short-term treatment of pain (less than 5 days)
Has to be taken multiple times a day
Has a risk of addiction and abuse
While taking Ultracet (tramadol / acetaminophen), you need to keep track of the total amount of acetaminophen (Tylenol) you are taking to avoid liver damage.
Not best option for people with liver problems
Pharmacist tips for Ultracet (tramadol / acetaminophen)
There are several prescription and over-the-counter (OTC) medications that contain acetaminophen (Tylenol). This can become a problem when taking Ultracet (tramadol / acetaminophen) because this combination medication also contains acetaminophen. If you're not sure if the medications you're taking contain acetaminophen, ask your provider or pharmacist. Limit the amount of acetaminophen you take per day to avoid any damage to your liver.
Ultracet (tramadol / acetaminophen) should only be used for 5 days or less for acute (short-term) pain. There is a risk for addiction, abuse, and misuse with this medication. Therefore, try to take the lowest dose for the shortest amount of time that's needed to treat your pain.
Ultracet (tramadol / acetaminophen) can make you sleepy. Avoid driving or other tasks that require you to be alert until you know how this medication affects you.
Don't take Ultracet (tramadol / acetaminophen) with alcohol. The acetaminophen component of Ultracet (tramadol / acetaminophen) can cause liver damage, and alcohol can raise this risk. Additionally, taking Ultracet (tramadol / acetaminophen) with alcohol can raise your risk of extreme sedation (drowsiness), breathing problems, coma, and even death.
Ultracet (tramadol / acetaminophen) can cause a sudden drop in blood pressure when changing positions, such as from sitting to standing. This is especially common when you first start Ultracet (tramadol / acetaminophen) and when the dose is changed. Be careful when changing positions to avoid falling and hurting yourself.
Frequently asked questions about Ultracet (tramadol / acetaminophen)
How to save using GoodRx
Ultracet (tramadol / acetaminophen) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 37.5mg/325mg | 12 tablets | $34.29 | $2.86 |
Typical dosing for Ultracet (tramadol / acetaminophen)
Your provider will work with you to prescribe the right dose of Ultracet (tramadol / acetaminophen) for your individual needs. It's recommended to use the lowest dose possible for the shortest duration of time to manage your pain.
In general, the starting dose is 2 tablets by mouth every 4 to 6 hours as needed for pain.
Each tablet contains 37.5 mg of tramadol and 325 mg of acetaminophen.
Interactions between Ultracet (tramadol / acetaminophen) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Furazolidone
- Iproniazid
- Isocarboxazid
- Linezolid
- Methylene Blue
- Moclobemide
- Nalmefene
- Naltrexone
- Nialamide
- Phenelzine
- Procarbazine
- Rasagiline
- Safinamide
- Selegiline
- Tranylcypromine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acepromazine
- Alfentanil
- Almotriptan
- Alprazolam
- Amifampridine
- Amineptine
- Amiodarone
- Amitriptyline
- Amitriptylinoxide
- Amobarbital
- Amoxapine
- Amphetamine
- Amprenavir
- Anileridine
- Aprepitant
- Aripiprazole
- Armodafinil
- Asenapine
- Atazanavir
- Baclofen
- Benperidol
- Benzhydrocodone
- Benzphetamine
- Boceprevir
- Bosentan
- Bromazepam
- Bromopride
- Bromperidol
- Brompheniramine
- Buprenorphine
- Bupropion
- Buspirone
- Butabarbital
- Butorphanol
- Calcium Oxybate
- Cannabidiol
- Carbamazepine
- Carbinoxamine
- Carisoprodol
- Carphenazine
- Ceritinib
- Cetirizine
- Chloral Hydrate
- Chlordiazepoxide
- Chlorpheniramine
- Chlorpromazine
- Chlorzoxazone
- Cimetidine
- Cinacalcet
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clobazam
- Clomipramine
- Clonazepam
- Clopidogrel
- Clorazepate
- Clozapine
- Cobicistat
- Cocaine
- Codeine
- Conivaptan
- Crizotinib
- Cyclobenzaprine
- Cyclosporine
- Darunavir
- Delavirdine
- Desipramine
- Desmopressin
- Desvenlafaxine
- Dexamethasone
- Dexmedetomidine
- Dextroamphetamine
- Dextromethorphan
- Dezocine
- Diazepam
- Dibenzepin
- Dichloralphenazone
- Difenoxin
- Dihydrocodeine
- Diltiazem
- Diphenhydramine
- Diphenoxylate
- Dolasetron
- Donepezil
- Dothiepin
- Doxepin
- Doxylamine
- Dronedarone
- Droperidol
- Duloxetine
- Efavirenz
- Eletriptan
- Enflurane
- Enzalutamide
- Erythromycin
- Escitalopram
- Esketamine
- Eslicarbazepine Acetate
- Estazolam
- Eszopiclone
- Ethchlorvynol
- Ethopropazine
- Ethylmorphine
- Etravirine
- Fenfluramine
- Fentanyl
- Flibanserin
- Fluconazole
- Fluoxetine
- Fluphenazine
- Flurazepam
- Fluspirilene
- Fluvoxamine
- Fosamprenavir
- Fosaprepitant
- Fosphenytoin
- Fospropofol
- Frovatriptan
- Gabapentin
- Gabapentin Enacarbil
- Granisetron
- Halazepam
- Haloperidol
- Halothane
- Hexobarbital
- Hydrocodone
- Hydromorphone
- Hydroxytryptophan
- Hydroxyzine
- Idelalisib
- Imatinib
- Imipramine
- Indinavir
- Isoflurane
- Isoniazid
- Itraconazole
- Ivacaftor
- Ketamine
- Ketazolam
- Ketobemidone
- Ketoconazole
- Lasmiditan
- Lemborexant
- Levocetirizine
- Levomilnacipran
- Levorphanol
- Lisdexamfetamine
- Lithium
- Lofepramine
- Lofexidine
- Lomitapide
- Lopinavir
- Lorazepam
- Lorcaserin
- Loxapine
- Lumacaftor
- Magnesium Oxybate
- Meclizine
- Melitracen
- Melperone
- Meperidine
- Mephobarbital
- Meprobamate
- Meptazinol
- Mesoridazine
- Metaxalone
- Methadone
- Methamphetamine
- Methocarbamol
- Methohexital
- Methotrimeprazine
- Metoclopramide
- Mibefradil
- Midazolam
- Mifepristone
- Milnacipran
- Mirabegron
- Mirtazapine
- Mitotane
- Modafinil
- Molindone
- Moricizine
- Morphine
- Morphine Sulfate Liposome
- Nafcillin
- Nalbuphine
- Naratriptan
- Nefazodone
- Nelfinavir
- Nevirapine
- Nicomorphine
- Nilotinib
- Nitrazepam
- Nitrous Oxide
- Nortriptyline
- Olanzapine
- Ondansetron
- Opipramol
- Opium
- Opium Alkaloids
- Orphenadrine
- Oxazepam
- Oxcarbazepine
- Oxycodone
- Oxymorphone
- Ozanimod
- Palbociclib
- Palonosetron
- Papaveretum
- Paregoric
- Paroxetine
- Peginterferon Alfa-2b
- Pentazocine
- Pentobarbital
- Perampanel
- Periciazine
- Perphenazine
- Phenobarbital
- Phenytoin
- Pimozide
- Piperacetazine
- Pipotiazine
- Piritramide
- Pixantrone
- Pneumococcal 13-Valent Vaccine, Diphtheria Conjugate
- Posaconazole
- Potassium Oxybate
- Prazepam
- Prednisone
- Pregabalin
- Primidone
- Prochlorperazine
- Promethazine
- Propofol
- Protriptyline
- Quazepam
- Quetiapine
- Quinidine
- Quinine
- Ramelteon
- Ranitidine
- Ranolazine
- Remifentanil
- Remimazolam
- Remoxipride
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rizatriptan
- Rolapitant
- Saquinavir
- Scopolamine
- Secobarbital
- Sertindole
- Sertraline
- Sibutramine
- Sodium Oxybate
- St John's Wort
- Sufentanil
- Sulpiride
- Sumatriptan
- Suvorexant
- Tapentadol
- Telaprevir
- Telithromycin
- Temazepam
- Terbinafine
- Thiethylperazine
- Thiopental
- Thiopropazate
- Thioridazine
- Tianeptine
- Tilidine
- Tizanidine
- Tolonium Chloride
- Topiramate
- Trazodone
- Triazolam
- Trifluoperazine
- Trifluperidol
- Triflupromazine
- Trimeprazine
- Trimipramine
- Tryptophan
- Venlafaxine
- Verapamil
- Vilazodone
- Voriconazole
- Vortioxetine
- Zaleplon
- Ziprasidone
- Zolmitriptan
- Zolpidem
- Zopiclone
- Zotepine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acenocoumarol
- Carbamazepine
- Fosphenytoin
- Lixisenatide
- Phenytoin
- Warfarin
- Zidovudine
How much does Ultracet (tramadol / acetaminophen) cost?
What are alternatives to Ultracet (tramadol / acetaminophen)?
Acute (short-term) pain
Pain that isn't relieved by non-opioid pain medications alone
Treatment of mild-to-moderate pain that isn't relieved by non-opioid pain medications alone
What is the latest news about Ultracet (tramadol / acetaminophen)?
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