Home Drug Guide Tramadol Hydrochloride and Acetaminophen

Drug Guide

Generic Name

Tramadol Hydrochloride and Acetaminophen

Brand Names Ultracet, Tramadol Hydrochloride And Acetaminophen

Classification

Therapeutic: Analgesic combination (opioid and non-opioid)

Pharmacological: Central analgesic (opioid receptor activity) and analgesic (acetaminophen)

FDA Approved Indications

  • Moderate to severe pain

Mechanism of Action

Tramadol binds to mu-opioid receptors and inhibits reuptake of norepinephrine and serotonin, contributing to analgesia. Acetaminophen inhibits prostaglandin synthesis in the CNS and differs from NSAIDs in its mechanism.

Dosage and Administration

Adult: Typically 37.5 mg/325 mg every 4 to 6 hours as needed, not to exceed 4 grams of acetaminophen per day.

Pediatric: Not approved for children under 12 years.

Geriatric: Start at lower end of dosing range, monitor hepatic function.

Renal Impairment: Use with caution; dose adjustments may be required.

Hepatic Impairment: Avoid or use at reduced doses, especially in severe liver disease.

Pharmacokinetics

Absorption: Rapid for both components.

Distribution: Widely distributed, crosses blood-brain barrier.

Metabolism: Tramadol metabolized in the liver via CYP2D6 and CYP3A4; acetaminophen metabolized in the liver.

Excretion: Renal excretion of metabolites.

Half Life: Tramadol approximately 6-7 hours; acetaminophen approximately 2-3 hours.

Contraindications

  • Hypersensitivity to tramadol or acetaminophen
  • Severe hepatic impairment
  • Use with monoamine oxidase inhibitors (MAOIs).

Precautions

  • History of seizures, drug abuse, respiratory depression, use in pregnancy and lactation.

Adverse Reactions - Common

  • Nausea (Common)
  • Dizziness (Common)
  • Drowsiness (Common)

Adverse Reactions - Serious

  • Serotonin syndrome (Rare)
  • Respiratory depression (Rare)
  • Hepatotoxicity (due to acetaminophen overdose) (Rare)

Drug-Drug Interactions

  • Serotonergic drugs (e.g., SSRIs, SNRIs) — risk of serotonin syndrome
  • CYP2D6 inhibitors — alter tramadol metabolism
  • Ethanol and hepatotoxic drugs — increase risk of hepatotoxicity.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor pain relief, respiratory status, liver function, and signs of serotonin syndrome.

Diagnoses:

  • Risk for respiratory depression
  • Impaired renal or hepatic function
  • Risk for substance abuse.

Implementation: Administer with food or water to minimize gastrointestinal upset; monitor patient closely for adverse effects.

Evaluation: Assess pain relief, monitor for adverse reactions, and evaluate liver function periodically.

Patient/Family Teaching

  • Take exactly as prescribed.
  • Do not exceed recommended dose of acetaminophen to avoid hepatotoxicity.
  • Report signs of allergic reactions, difficulty breathing, or signs of serotonin syndrome.
  • Avoid alcohol and sedatives while on this medication.

Special Considerations

Black Box Warnings:

  • Serious, potentially life-threatening respiratory depression and accidental ingestion, especially in children.
  • Hepatotoxicity associated with overdose of acetaminophen.

Genetic Factors: Polymorphisms in CYP2D6 may alter tramadol metabolism and effectiveness.

Lab Test Interference: May affect liver function tests.

Overdose Management

Signs/Symptoms: Nausea, vomiting, sweating, confusion, respiratory depression, coma, elevated liver enzymes (acetaminophen overdose).

Treatment: Naloxone for opioid toxicity; acetylcysteine for acetaminophen overdose; supportive care.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable until the expiration date printed on the package.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.