Pain Home > Precautions and Warnings With Tramadol/Acetaminophen

There are many precautions and warnings with tramadol/acetaminophen to be aware of before starting treatment. For example, it is important to know that the medication can potentially cause slow and irregular breathing, seizures, and dizziness. You should not take tramadol/acetaminophen if you are allergic to any components of the medicine or to other narcotics or opiates.

Tramadol/Acetaminophen: What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking tramadol/acetaminophen (Ultracet®) if you have:
  • Seizures or epilepsy
  • A history of drug or alcohol dependence
  • A head injury or high intracranial pressure
  • Kidney disease, such as kidney failure (renal failure)
  • Liver disease, such as cirrhosis, liver failure, or hepatitis
  • Any allergies, including allergies to foods, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Breastfeeding
  • Pregnant or thinking of becoming pregnant.
Make sure to tell your healthcare provider about any other medications you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Specific Warnings and Precautions for Tramadol/Acetaminophen

Warnings and precautions to be aware of prior to taking tramadol/acetaminophen include the following:
  • Tramadol/acetaminophen can cause seizures. You may be more likely to experience seizures due to tramadol/acetaminophen if you already have a seizure disorder, if you take certain other medications, or if you are going through alcohol or drug withdrawal.
  • Tramadol/acetaminophen can potentially interact with several other medications (see Drug Interactions With Tramadol/Acetaminophen).
  • Tramadol/acetaminophen contains acetaminophen (Tylenol®). Taking too much tramadol/acetaminophen, or taking tramadol/acetaminophen in combination with other products that contain acetaminophen, can cause severe liver problems or even death due to Tylenol poisoning. Tramadol/acetaminophen may not be a good choice for people who already have liver disease.


  • The tramadol component of this medication can cause a dangerous group of symptoms known as serotonin syndrome. This is more common when it is combined with certain other medications (see Tramadol and Serotonin Syndrome for more information).


  • Tramadol/acetaminophen is an opioid medication with potential for abuse. It is not a good choice for people with a history of alcohol or drug abuse. Do not take the drug more frequently, longer, or at a higher dose than prescribed. If you feel you may be developing a problem with tramadol/acetaminophen, please seek help from your healthcare provider (see Addiction to Ultracet).
  • Tramadol/acetaminophen can cause slow and irregular breathing. In severe situations, this may be life-threatening. This may be especially dangerous in people with lung problems.
  • The medication can cause problems in people with head injuries or high intracranial pressure. Tramadol/acetaminophen should only be used with extreme caution in such circumstances.
  • Do not drive or operate heavy machinery until you know how tramadol/acetaminophen affects you. Your reflexes and reaction times may be significantly affected, even if you feel fine.
  • Like any other narcotic, tramadol/acetaminophen can cause dizziness and drowsiness, and may increase the risk of falls in elderly people.
  • Tramadol/acetaminophen is considered a pregnancy Category C medication. This means that it may not be safe for use during pregnancy, although the full risks are not known (see Ultracet and Pregnancy).
  • Tramadol/acetaminophen passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Ultracet and Breastfeeding).
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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