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Drug Monograph: Ultracet / Tramadol With Acetaminophen This monograph discusses the use of Ultracet (acetaminophen with tramadol combination) for pain management. Acetaminophen is a non-narcotic analgesic and tramadol is a centrally acting analgesic with a unique, dual mechanism of action. The primary advantage of Ultracet appears to be a quicker onset of action than Ultram and greater pain relief than either acetaminophen or tramadol given alone.
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Some side effects can be serious. If you experience any of these symptoms or those listed in the SPECIAL PRECAUTIONS section , call your doctor immediately: seizures sores on the inside of your mouth, nose, eyes, or throat flu-like symptoms hives rash difficulty swallowing or breathing swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs hoarseness hallucinations (seeing things or hearing voices that do not exist)
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8:38 PM, Susan in Montana said... I have a question about Tramodoland Deramaxx, too, I guess. My vet had prescribed Deramaxx for our 10-year-old Golden Retriever's arthritis and I had been giving him the maximum dose since last summer. A few weeks ago I took him in to the vet. They did some blood tests and discovered elevated creatinin, indicating decreased kidney function. We did two more blood tests after that, finding that his creatinin was indeed elevated. The vet took him off the Deramaxx and put him on Tramadol. I am concerned because some websites say that Tramadol is not good if a dog has compromised kidney function. I am noticing also that he is now drinking more wateris this a good sign or a bad sign? Is the decreased kidney function from the use of Deramaxx permanent? Thanks so much for your help.
... Comment #9: day next tramadol ...In the gap between non-steroidal anti-inflammatory drugs (NSAIDs) like Rimadyl and Deramaxx, which some dogs cannot tolerate and some owners aren't willing to give, and can rarely be safely used in cats, and heavy-duty narcotics like Fentanyl and morphine, is a human pain drug getting recent increased attention in veterinary practice. This is the drug tramadol (Ultram).I first heard of tramadol when it was prescribed for post-surgical pain for a dog of mine at the specialty practice where he had his surgery. Being the kind of dog owner I am, I investigated it thoroughly before giving it to him, and when I did, I wondered how I'd managed to miss it before - and to wish I'd known about it when I had a senior dog who became intolerant of NSAID drugs, and ended up being put to sleep when I could no longer control her pain or maintain her quality of life.There are many ways to inhibit pain. NSAIDs do so by interfering with the production of an enzyme known as "cyclo-oxygenase," or "COX," which is involved in inflammation (as well as many beneficial and essential organ functions). The class of drugs known as opioids does so by stimulating opiate receptors in the brain. Some opiate receptors are responsible for beneficial effects such as pain relief, while others can produce hallucination, sedation, and heart and respiratory problems. Tramadol works by stimulating the "mu" receptor, which provides pain relief without sedation and without addiction.Some Side Effects and ContraindicationsLike all drugs, tramadol has side effects, although they are usually mild. There is a wide range of possible dosing with this drug, and sedation sometimes can occur at higher doses; if this happens, it is recommended that the dosage be reduced.Constipation can occur rarely in some dogs, and will resolve when the drug is discontinued.Although tramadol does not harm the gastrointestinal lining as NSAID drugs can, it can cause nausea. This is rare.Contraindications include dogs who are being treated with L-Deprenyl for Cushings or cognitive disorders, or dogs taking serotonin reuptake inhibitors, monoamine oxidase inhibitors, or certain antidepressant medications.Note: The human drug Ultracet is a combination of Ultram (tramadol) and Tylenol (acetaminophen). This drug must not be given to animals.FeaturesUnlike NSAIDs, tramadol can be taken with steroids. It can also be taken with NSAIDs to provide additional pain relief and allow a lower dose of both drugs to be used.Tramadol is a prescription human medication and will require a prescription from a veterinarian. It is not a controlled substance and no special paperwork is required to prescribe, stock, or dispense this medication in veterinary practice.Tramadol is not passed to nursing puppies through the dam's milk so can be used for pain control in lactating bitches.Dosing InformationThere is a wide range of dosing possible with this medication. Within the recommended safe dosing levels as given in the veterinary literature, it's possible to experiment with different intervals and amounts to achieve the desired level of pain relief and minimize unwanted effects or sedation. Some animals do very well on the minimum dosage given in two equal doses, 12 hours apart, while others might need the same dose, but given in six doses 4 hours apart, or four doses 6 hours apart, or three doses 8 hours apart. And still other animals might need a higher overall dose, given at any of those intervals.The lower doses are typically used for chronic pain relief, such as with arthritis pain, while the higher are for severe post-surgical pain. But this is extremely variable and each animal's and owner's needs should be taken into account on an individualized basis before a dosage schedule is finalized. For example, sometimes giving a slightly higher overall dosage at greater intervals will allow the animal to experience relief of pain without the owner having to adminster the medication repeatedly throughout the day (which is not always possible).Because tramadol is not in widespread use yet in veterinary practice, it's possible that a veterinarian you consult or work for is not familiar with it. For more information, including recommended dosages, veterinary professionals should consult
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Tramadol has been shown to be embryotoxic and fetotoxic in mice, (120 mg/kg or 360 mg/m²), rats (≥25 mg/kg or 150 mg/m²) and rabbits (≥75 mg/kg or 900 mg/m²) at maternally toxic dosages, but was not teratogenic at these dose levels. These dosages on a mg/m² basis are 1.4, ≥0.6, and ≥3.6 times the maximum daily human dosage (246 mg/m²) for mouse, rat and rabbit, respectively.
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Langford RM, Bakhshi KN, Moylan S, Foster JMG. Hypoxaemia after lower abdominal surgery: Comparison of tramadol and morphine. Acute Pain 1998;1:7-12.
2:22 PM, Anonymous said... My 15-year old border collie/Rott mix was just prescribed 1/2 pill of Tramadol twice a day. He is also on one Anipryl (l-deprenyl) each morning, and a 1/2 Deramaxx pill with evening dinner. (He limps and has trouble with stairs. Vet says he has nerve degeneration of the lower spine called something like, "spando..??). She also thinks he has arthritis and his back left hip may have been dislocated at some point because it twists a little when he walks. Is Tramadol and Anipryl safe together???? You say it's contraindicated.thankskaren
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Hops H, Tildesley E, Lichtenstein E, Ary D, Sherman L (1990). "Parent-adolescent problem-solving interactions and drug use". The American journal of drug and alcohol abuse 16 (3-4): 239-58.
... Comment #198: tramadol hydrochloride ...In our study, although pain intensity score was comparable between the two groups at any time, patients in the Propacetamol group needed considerably higher dose of morphine for pain control (8.50 + 5.15 vs. 4.75 + 4.9;P = 0.025) than Tramadol group. It seems that equal pain control in the Propacetamol group was achieved at the expense of more morphine consumption. Need for rescue medication was also more in the Propacetamol group, as 10 patients (50%) in this group needed additional morphine compared to 3 patients (15%) in the Tramadol group (P= 0.041).
10- Schaffer J, Hagemann H, Holzapfel S, Panning B, et al. Investigation of Tramadol for post-operative analgesiain children. Forschr Anesth 1998; 3: 42-45.
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... Comment #170: worlwide shipping tramadol mastercard only ...The decision to prescribe tramadol should not be a trivial one. Tramadol has a place in pain management for selected patients who have not responded to simple analgesics such as paracetamol or aspirin and in whom NSAIDs are contraindicated. For most patients, a combination of paracetamol and codeine will be equally effective and possibly better tolerated than tramadol. In order to minimise adverse effects, patient factors should be carefully considered and the patient’s medication history must be carefully reviewed.
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Nancy Campbell RVT said... You'll need to ask your vet. There are so many alternatives for pain control that I think it is best left up to your vet to decide what would be best for your pet. Sorry, I couldn't be of more help.
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In studies including geriatric patients, treatment-limiting adverse events were higher in subjects over 75 years of age compared to those under 65 years of age. Specifically, 30% of those over 75 years of age had
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Once a person has transitioned from drug use to addiction, behavior becomes completely geared towards seeking the drug, even though addicts report the euphoria is not as intense as it once was. Despite the differing actions of drugs during acute use, the final pathway of addiction is the same. Another aspect of drug addiction is a decreased response to normal biological stimuli, such as food, sex, and social interaction. Through functional brain imaging of patients addicted to cocaine, scientists have been able to visualize increased metabolic activity in the
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8:38 PM, Susan in Montana said... I have a question about Tramodoland Deramaxx, too, I guess. My vet had prescribed Deramaxx for our 10-year-old Golden Retriever's arthritis and I had been giving him the maximum dose since last summer. A few weeks ago I took him in to the vet. They did some blood tests and discovered elevated creatinin, indicating decreased kidney function. We did two more blood tests after that, finding that his creatinin was indeed elevated. The vet took him off the Deramaxx and put him on Tramadol. I am concerned because some websites say that Tramadol is not good if a dog has compromised kidney function. I am noticing also that he is now drinking more wateris this a good sign or a bad sign? Is the decreased kidney function from the use of Deramaxx permanent? Thanks so much for your help.
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bioequivalence to the innovator product. Over the past several years there have been studies that have shown the effectiveness and safety of some generic drugs. Generic drugs are always less expensive and can save patients and insurance companies thousands of dollars supposedly without compromising the quality of care. The FDA must approve generic drugs just as innovator drugs must be approved. Bioequivalence, however, does not mean that generic drugs are exactly the same as their innovator product counterparts, as chemical differences do exist. Some doctors and patients emphatically believe that certain generic drugs are not as effective as the products they are meant to replace (ie. Prozac, Oxycontin), and consumers would undoubtedly benefit from more clinical studies done on drug by drug basis. Generic drugs start out at first being fairly expensive, however the price of the generic product decreases as the rate of production increases.
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A controlled study that compared different medications found "the percent of subjects who scored positive for abuse at least once during the 12-month follow-up were 2.5% for NSAIDs, 2.7% for tramadol, and 4.9% for hydrocodone. When more than one hit on the
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Moshe said... I got a weeks worth of Rimadyl because my vet is convinced the trembling is because of pain, and the trembling/shaking seemed to decrease somewhat, though she still had the shaking sometimes. When discussing the high cost of Rimadyl, my vet said I could try Tramadol instead, as it is cheaper. So right now she is on her last (7th) day of Rimadyl, and starts
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Patients received either Tramadol 100 mg IV or Propacetamol 2 gr IV at T0 and then 50 mg Tramadol or 1.5 gr Propacetamol at 6, 12, 18 and 24 hours if pain was present.
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Tramadol does not appear to induce its own metabolism in humans, since observed maximal plasma concentrations after multiple oral doses are higher than expected based on single-dose data. Tramadol is a mild inducer of selected drug metabolism pathways measured in animals.
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9:08 AM, Anonymous said... My senior dog has been on tramadol for a couple weeks now but it seems to make him woozy at times. He gets 25 mg in the morning and around 10 p.m. He hasn't slept well at night for the last year or so and the tramadol does seem to help with that sort of. At night, he usually sleeps for an hour or so then is up and pacing fairly quickly for an hour or so around midnight, which makes me think it helps the pain. Then he goes to sleep for a couple hours, but wakes up again around 4 a.m. Sometimes I get up with him and he walks around a little, and sometimes I can just lay him on his other sides and he goes back to sleep and sleeps very soundly the rest of the night. When I have to wake him up in the morning so I can go to work, he seems disoriented. He circles to the right constantly and can hardly walk in a straight line, even with me leading him by collar and tail. (He does this a little bit anyway, which may be a pain or injury thing, but he does it much more after tramadol.) My dog weights 43 lbs. I started chipping off a little piece of his Tramadol pill to give him a smaller dose to see if that helps. My vet just began prescribing tramadol and doesn't have any experience with it yet. Any suggestions? Does this sound like it's from the tramadol or could it just be a pain response?
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DRUG ABUSE AND DEPENDENCE). ULTRAM should not be used in opioid-dependent patients. ULTRAM has been shown to reinitiate physical dependence in some patients that have been previously dependent on other opioids. Dependence and abuse, including drug-seeking behavior and taking illicit actions to obtain the drug, are not limited to those patients with prior history of
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bone marrow micronucleus tests in mice and Chinese hamsters. Weakly mutagenic results occurred in the presence of metabolic activation in the mouse lymphoma assay and micronucleus test in rats. Overall, the weight of evidence from these tests indicates that tramadol does not pose a genotoxic risk to humans.
Your pharmacist has more information about tramadol written for health professionals that you may read.
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Tramadol undergoes serotonergic modulating properties of tramadol mean that it has the potential to interact with other serotonergic agents. There is an increased risk of
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Boureau F, Legallicier P, Kabir-Ahmadi M (2003). "Tramadol in post-herpetic neuralgia: a randomized, double-blind, placebo-controlled trial". Pain 104 (1–2): 323–31.
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If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at
Do not crush the tramadol tablet. This medicine is for oral (by mouth) use only. Powder from a crushed tablet should not be inhaled or diluted with liquid and injected into the body. Using this medicine by inhalation or injection can cause life-threatening side effects, overdose, or death. Do not crush, chew, break, or open a controlled-release, delayed-release, or extended-release tablet or capsule. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time. If you use the tramadol extended-release tablet, the tablet shell may pass into your stools (bowel movements). This is normal and does not mean that you are not receiving enough of the medicine.
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Respiratory depression and constipation are less common with tramadol and less pronounced than with other opioids. However, respiratory depression can occur, in particular, after overdose and with impaired renal function. Unlike other opioids, tramadol is not usually associated with the development of tolerance, physical dependence or psychological addiction. In clinical trials the most common adverse reactions, in decreasing frequency, were nausea, dizziness, drowsiness, tiredness, fatigue, sweating, vomiting, dry mouth and postural hypotension. Tramadol may possibly increase the risk of seizures in those with a history of epilepsy or those on medication, which lowers the seizure threshold, but it appears that tramadol does not induce idiopathic seizures except at very high doses. Tramadol is contraindicated in users of MAO inhibitors as a safety precaution and, because of the risk of serotonin syndrome, should be used with caution in combination with SSRIs.
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