Tramadol is a narcotic-like pain reliever. Acetaminophen is a less potent pain reliever that increases the effects of tramadol.

The combination of acetaminophen and tramadol is used to treat moderate to severe pain.

Acetaminophen and tramadol may also be used for purposes not listed in this medication guide.

Tell your doctor if you have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic beverages per day. You may not be able to take medicine that contains acetaminophen.

Do not take more of this medication than is recommended. An acetaminophen and tramadol overdose can damage your liver or cause death. The maximum amount of acetaminophen and tramadol is 2 tablets per dose, or 8 tablets per day.

You should not take this medication if you are allergic to acetaminophen and tramadol, if you are intoxicated (drunk), or if you have recently used narcotic pain medicine, a sedative or tranquilizer, medicine for depression or mental illness, or any type of street drug.

Do not drink alcohol while you are taking acetaminophen and tramadol. Alcohol may cause a dangerous decrease in your breathing when used together with acetaminophen and tramadol. Alcohol may also increase your risk of liver damage while taking acetaminophen.

Acetaminophen and tramadol may be habit-forming and should be used only by the person it was prescribed for. Never share this medication with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

You should not take this medication if you are allergic to it, if you are intoxicated (drunk), or if you have recently used any of the following drugs:

• alcohol;

• tramadol (Ultram) or narcotic pain medicine;

• sedatives or tranquilizers (such as Valium);

• medicine for depression or anxiety;

• medicine for mental illness (such as bipolar disorder, schizophrenia); or

• street drugs.

Tell your doctor if you have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic beverages per day. You may not be able to take medicine that contains acetaminophen.

Seizures have occurred in some people taking acetaminophen and tramadol. Your risk of a seizure may be higher if you have any of these conditions:

• a history of drug or alcohol addiction;

• a history of epilepsy or other seizure disorder;

• a history of head injury;

• a metabolic disorder;

• an infection of your brain or spinal cord, such as meningitis or encephalitis;

• if you are also taking an antidepressant, mood stabilizer, or another narcotic pain medicine; or

• if you have taken an MAO inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

Talk with your doctor about your individual risk of having a seizure.

To make sure you can safely take acetaminophen and tramadol, tell your doctor if you have any of these other conditions:

• kidney disease;

• liver disease;

• asthma or other breathing disorder;

• a stomach disorder; or

• a history of depression, mental illness, or suicide attempt.

Acetaminophen and tramadol may be habit-forming and should be used only by the person it was prescribed for. Never share this medication with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

FDA pregnancy category C. It is not known whether the combination of acetaminophen and tramadol is harmful to an unborn baby. Tramadol alone may have caused serious or fatal side effects in newborns of mothers who used the medication during pregnancy or labor. Tell your doctor if you are pregnant or plan to become pregnant during treatment with acetaminophen and tramadol.

Acetaminophen and tramadol can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.