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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104 Comments to “Tramacet”

  1. I've had an lower spine operation 3 months ago. I use 2 x 200mg Tramacet every 8 hours. I still suffer from Sciatica and take Lyrica for that 2 x daily. On top of that I am being treated for inflammation in my upper left arm.

    I want to reduce the pain killers but as soon as I start I get withdrawal systems, anxiety, shivering. What is the safest way to reduce the medication

    Comment by Johan W Bruwer — June 4, 2019 #
    Reply

    1. @Johan W Bruwer,

      You need to reduce gradually and with the input and support of your doctor or local healthcare provider. Lower strength versions are likely to be available - so 100mg and perhaps 50mg which will allow you to reduce your dose more slowly and lessen the withdrawal effects.

      Comment by Matthew Robinson — June 5, 2019 #
      Reply

  2. I recently started taking tramadol 4 times a day for pain in my back and legs it did help for a while but I've put on weight and the tablets have stopped working my doctor sent me to hospital for a MRI scan and it came back saying nothing had been found. I get pain in my hip starting elbows and knees too.

    Comment by Judith Dunderdale — September 13, 2018 #
    Reply

    1. @Judith,

      Scans be be reassuring that there is nothing majorly wrong but can also be confusing when they find nothing and therefore don't explain the pain. Try not to worry about the results of the scan and see if you can discuss how to manage you pain a little better so that you can get on wuth day to day activities.

      Comment by Matthew Robinson — September 14, 2018 #
      Reply

  3. I have been using Tramcet 1 four times a day for almost 3 years now for fibromyalgia en Myasthenia gravis complications. The last 2 weeks were terrible, I felt sweaty, nauseous, I had very bad problems breathing and had to up my Mestinon in order to breath better. I also felt dizzy a lot. I stopped the Tramacet 3 days back and feel wonderful. I can breath properly, no more dizzyness and my Mestinon is back to normal old dosages. My question to you is can a person develop a reaction to Tramacet after such a long time of usage?

    Comment by Erna Pretorius — October 23, 2017 #
    Reply

    1. @Erna

      Developing a side affect after quite a long time is unusual but entirely possible. Changes to other treatments, your overall health, changes in lifestyle or the ageing processes effects on your body can all play a part in side effect profiles of medicines.

      Comment by Matthew Robinson — October 23, 2017 #
      Reply

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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 #

  10. 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

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