Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Tramacet

Tramacet has been launched recently and is being heavily promoted in the form of adverts and journal inserts. It contains 325mg of Paracetamol and 37.5mg of Tramadol per tablet.

Given the recent announcement of the withdrawal of Co-proxamol, we feel it would be inappropriate to transfer patients to this drug. We are also concerned that this new product contains subtherapeutic doses of both ingredients.

It currently costs £10.07 for 60 tablets which is over £9 more than the cost of 100 Paracetamol and £3 more than 100 Co-codamol 30/500mg tablets.

Action: There can be no good reason to use Tramacet in any circumstance.

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94 Comments to “Tramacet”

  1. Hi there, I have been using Tramacet for 3 years now for the upper back pain, I only took 2-4 tablets a day but the problem is I'm trying to withdraw but the pain can not stop. What else can the doctor do to help me in this case? I'm very tired of taking this pills everyday day and if I stop I can't sleep because of the pain.

    Comment by Jonas — October 19, 2017 #
    Reply

    1. @Jonas

      You need to go and discuss options with your doctor. It sounds like you need help coming off the tramacet and an alternative that is more acceptable for you needs to be found too.

      Comment by Matthew Robinson — October 20, 2017 #
      Reply

  2. Hi there, my mom takes Tramacet now for 4 years, sometimes she has "tremors". And I cannot figure out if it is from the tramacet because she doesn't have them daily? I always warn her that maybe she takes them closer than 6 hours and that's what causes it? Am I right or wrong? If it was the tablets won't she have it every time she takes it or just when it's to close to previous dose?

    Please help me
    Cornell

    Comment by Cornell — August 21, 2015 #
    Reply

    1. @Cornell

      If this was a side effect of the medication I would expect to see it when the medication was taken and it would not be present when the medication has not been taken. It is possible it could be a dose related side effect which might therefore become more apparent when the medication is taken in higher doses and more frequently.

      "Trembling" and "Involuntary muscle contractions" are both known but rare side effects of tramadol - one of the ingredients in Tramacet. Rare means they occur in between 1 in 1,000 and 1 in 10,000 people who take the medication.

      If you are sufficiently worried you should get your mom to see her doctor and discuss this.

      Comment by Matthew Robinson — August 22, 2015 #
      Reply

  3. Hi, I have been taking Tramacet for about 12 months for osteoarthritis and have got dosage down to 1 in the morning and 1 at night. I am experiencing bad leg cramps mainly at night - is this a side effect of taking medication for so long? Can I continue taking these pill at this dosage - as it seems to control the pain?

    Comment by Pat Munton — January 9, 2015 #
    Reply

    1. @Pat,

      Leg cramps are a known side effect of tramadol. It might be the medication or something else though - it depends when you started the medication and when the cramps started. If they are helping with the pain it's worth speaking to your doctor and discussing the benefits and also the likelihood that they are causing the cramp. Then decide if it is better to continue or try something different.

      Comment by Matthew Robinson — January 9, 2015 #
      Reply

  4. I have been prescribed tramacet for fibromyalgia. It helps so much with the pain. I feel that I am now able to complete some of the everyday tasks that I haven't been able to do for a few years. It probably increases my appetite though which isn't good. But I find that when the medication starts wearing off and I am ready for the next dose I am getting more pain than I did. I am wondering if this is just because my body is now doing so much more than I have been able to and I am overdoing it, or if it is a direct result of the medication wearing off linked to its addictive nature? (I have only been taking it ten days)

    Comment by Jenny — July 18, 2014 #
    Reply

    1. @Jenny,

      Periods of worsening pain when taking analgesics can be caused by hyperalgesia - or an increased sensitivity to pain. But this usually happens after longer term and high dose exposure. So, I would expect it's because you are making the most of the good pain control and doing a little bit too much at the moment.

      Comment by Matthew Robinson — July 18, 2014 #
      Reply

  5. I have been taking Tramacet for about 18 months now and it has been brilliant in controlling the pain of arthritis. But recently my Doctor has put me on Co-codamol which do absolutely nothing for my pain. He says it has an affect on the brain? But I work 15hour days and I am finding it hard to cope with the pain. I only took 2-4 per day could you advise on what I should do? I am a carer and work with the elderly. He sent me to physio but they can't do anything, they say. I am doing everything that I should be doing, I am feeling desperate.

    Comment by Joyce — June 20, 2014 #
    Reply

    1. @Joyce,

      You need to go back and speak to your doctor again. You haven't said what strength of co-codamol you were given (that are different strengths) so it may be something as simple as getting the dose right for you. It may also be a case that the switch hasn't worked for you so you may be offered something different again or a return to the original prescription. But for anything to change you need to speak to your doctor.

      Comment by Matthew Robinson — June 21, 2014 #
      Reply

  6. My doctor recently switched me from tramacet, which I was taking 6 a day for the last 4 years, to Nucynta. I feel shaky, hot/cold flashes and dizzy even though I'm taking 1 Nucynta every 4 hours. Am I withdrawing from Tramadol even though I'm still taking pain meds?

    Comment by Wannetta — November 26, 2013 #
    Reply

    1. @Wannetta,

      I suppose it could be possible if the dose has not been converted adequately or it could be coincidence or maybe even a side effect. I think it would be worthwhile checking with your doctor if this doesn't resolve quickly.

      Comment by Matthew Robinson — November 26, 2013 #
      Reply

      1. Thank you Matthew. Will try to bear it a few more days and get in contact with my doctor. The dosage is 1-2 every four hours. Will try 2 at bedtime and see if it gives me enough relief to sleep through the night.

        Comment by Wannetta — November 27, 2013 #
        Reply

      2. I should have mentioned the reason I asked if it was withdrawal from tramacet is because about a half hour after I take the Nucynta the symptoms go away and then they start again close to or shortly before I take the next dose.

        Comment by Wannetta — November 27, 2013 #
        Reply

        1. @Wannetta,

          That sounds very much like it is down to low blood levels of the drug shortly before the next dose is taking. It may improve with time but you should probably discuss with your doctor as the dose or formulation of the new medication may not be quite right for you if this is happening.

          Comment by Matthew Robinson — November 27, 2013 #
          Reply

          1. Thank you again. I do know I can't tolerate anything stronger. I had a consult with my doctor and it turns out I am having severe side effects of nucynta. I can't say thank you enough for your help. Hoping she keeps me with tramacet and baclofen as they seem to work for my medical conditions.

            Comment by Wannetta — November 27, 2013 #

  7. Help, I was addicted to xanor was on it for 10 years! Also addicted to codeine. Oh the withdrawals were BAD. It is now 7 months since I stopped. Low and behold! I'm now addicted to tramacet!! 2 tablets 4 times a day. Don't fancy going through the withdrawal crap AGAIN. I'm 58 years old! I reckon I have an addictive personality???

    Comment by Mimsi — March 29, 2013 #
    Reply

    1. @mimsi,

      If you are taking these pain killers to treat a painful condition then you should be worrying about addiction. If you are just taking them without a good reason then addiction is quite likely to occur however with a careful approach to a dose reduction any withdrawal effects can be minimised and possibly avoided completely. If you want to stop these tables speak to your doctor before you start reducing the dose so that you get the right help.

      Comment by Matthew Robinson — March 30, 2013 #
      Reply

  8. I was initially prescribed Tramahexel but due to no available stock, I am now taking Tramacet for severe osteoarthritis. Both these tablets relieve the pain miraculously and I don't have any side effects. But I have been told recently by a nursing sister that all these Trama.... medicines are very bad for me. Why is that?

    Comment by Claudia — September 25, 2012 #
    Reply

    1. @Claudia,

      These medicines, if used appropriately, are fine. Tramadol does have some side effects that make some clinicians wary about using this medication if the safer alternatives have not been tried first.

      Comment by Matthew Robinson — September 26, 2012 #
      Reply

  9. Hi

    I have a staff member who is on Tramacet after a vehicle accident. He claims he cannot work because he is hallucinating and is drowsy. Does this sound likely?

    Comment by Frank Hayward — July 30, 2012 #
    Reply

    1. @Frank,

      Tramadol, one of the ingredients in Tramacet, can cause both of these side effects.

      Comment by Matthew Robinson — July 30, 2012 #
      Reply

  10. I have been taking Tramacet for several years for fibromyalgia but recently they have not worked so well. My doctor gave me Naproxen, so for several days I was not taking the Tramacet. I had two bad nights of severe 'restless legs', red hot skin, and the shivers, flu like symptoms, like a bad cold, and unable to sleep. Once I started taking the Tramacet again all these symptoms disappeared. I do not know whether these symptoms were caused by stopping the Tramacet or starting the Naproxen.

    Comment by Audrey — June 16, 2012 #
    Reply

    1. @Audrey,

      Those symptoms all sound very much like withdrawal from the tramadol ingredient in the Tramacet. If you are supposed to be stopping them I'd suggested you wean down gradually rather than abruptly stopping them.

      Comment by Matthew Robinson — June 16, 2012 #
      Reply

      1. Thank you Matthew for your advice. You are right of course, I did try to stop them suddenly. I will do what you advise. I do not wish to experience those symptoms again.

        Comment by Audrey — June 17, 2012 #
        Reply

  11. My Husband was in a vehicle accident in August 2011. His leg was badly damaged, the doctor put steel to hold his leg together, I tried several pain medicine, nothing really helped until I then got some Hydrocone which help but was unable to get more when the supplied finished then I tried the Tramacet which he's presently using 2 at night time only. This was a blessing for this is really helping with the pain. How long will he be able to use this for? I don't want him to addicted to pain killers.

    Comment by Roses — December 8, 2011 #
    Reply

    1. Roses,

      I think your husband is unlikely to become physically addicted to Tramacet if he's only taking two at night.

      Comment by Matthew Robinson — December 8, 2011 #
      Reply

  12. Hi
    I am thinking about asking me doctor to put me on tramacet as I have used Tramadol in the past which helped for many years but after 10 years of taking them they stopped working. I also take celebrex as I have many allergies to medication especially pain killers. I have fibromyalgia and a few other conditions. I cant take morphine, viox, disafenic as I am allergic to them.

    when I start started taking tramadol I felt very ill for about 10 days but once that was over it was fine. The best combination that I had was tramadol and celebrex as that give the most pain relief.
    Dee

    Comment by Deetramacet — July 12, 2011 #
    Reply

  13. Hi iv been taking Tramacet for about a week now for severe back pain and, but I have noticed all down my right arm and my hand goes numb and my leg twitches, is this normal?

    Comment by Niki — April 4, 2011 #
    Reply

  14. @ judy parry,, hi r u the same judy parry who worked as a councillor over 20yrs ago?

    Comment by Michelle — February 22, 2011 #
    Reply

  15. Thanks for the information. Should I get her off of Tramadol as she keeps saying she is getting hot flushes. She has been on it since Tuesday 2 pills every four hours. I know the pain is not causing the hot flushes. Does she go off it cold turkey or slowly and how slowly

    Thanks

    Comment by Dennis — January 23, 2011 #
    Reply

    1. @Dennis,

      It's going to be a case of taking the lesser of 2 evils. Is your wife better off with the hot flushes and being relatively pain free or is she better off with no hot flushes and in some more pain? That is something only she can decide as only she will know how bad these symptoms are relative to each other.

      If the pain is easing she could reduce her pain killer use and with that the side effects should also start to fade. Suddenly stopping the pain killers would not normally be advisable though as her pain may become quite severe, although she would unlikely get withdrawal effects after such a short period of treatment.

      Comment by Matthew Robinson — January 23, 2011 #
      Reply

  16. My wife just had a historectomy and she did not want codiene as it would cause constipation. The doctor put her on Tramacet instead. Today is the fifth day since sugery and she says for a few days now she twitches at night trying to sleep, feels hot and has no appetite. yesterday she tried to take only one pill but after a few hours her pain was a 6/10 so she took two the next time she took meds. What is causing this strangeness? What elese can she take for her pain that is not addicting if this is what is happening

    Comment by Dennis — January 22, 2011 #
    Reply

    1. @Dennis,

      I would suspect the tramadol in the Tramacet as the cause of the twitching legs and maybe the other symptoms too. She still obviously needs some pain killers so it's worth discussing with the doctors. Yes, codeine can cause constipation, but so can lying in bed after a hysterectomy and so can tramadol. Any constipation can always be remedied with laxative treatment while the pain killers are necessary.

      Comment by Matthew Robinson — January 22, 2011 #
      Reply

  17. I,m sitting here feeling rotten I have been taking tramaset for over 3 years now and I have decided to slowly get myself off them. I was prescibed them for server back ache and only took them when I needed them but slowly over time I have ended up taking them 4 times a day even when I didnt really need them for pain. Yep I would say I was addicted to them because I have cut down to 2 twice a day and I slowly doing it that way. I have all I can describe is a whooshie head hot and cold and what is like bumblebees in my head, and I feel completey washed out and could sleep at the drop if a hat.It feels like I have flu on the way all the time, but I dont care I,m not giving up I,m going to beat this. The reason I have decided to come off them is that I have developed IBS since having my Gall Bladder removed due to Gall Stones and the constipation is unbeliveable and I,m sure is the drugs that are causing it. Good luck to all those trying to give this awful drug up

    Comment by Helen — September 26, 2010 #
    Reply

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