TM-Plus Tablet

Combination of a weak opioid and paracetamol for:

• Short-term relief of moderate to severe pain (e.g. after surgery, dental pain, musculoskeletal pain) when paracetamol alone is not enough

Adults and children over 12 years: tramadol 37.5 mg + paracetamol 325 mg — start with 2 tablets, then 1–2 tablets every 6 hours as needed.

• Maximum 8 tablets per day (300 mg tramadol, 2.6 g paracetamol).
• Use for the shortest time possible (usually not more than 5 days for acute pain).
• Elderly over 75: longer intervals; kidney impairment (CrCl < 30): every 12 hours.
• Do not take other paracetamol-containing medicines at the same time.

• Allergy to tramadol, opioids or paracetamol
• Acute intoxication with alcohol, sleeping tablets, opioids or psychotropic drugs
• Use with MAO inhibitors (or within 14 days)
• Uncontrolled epilepsy
• Severe liver impairment, severe respiratory depression
• Children under 12; post-tonsillectomy pain in under 18

Very common: nausea, dizziness, drowsiness.

Common: headache, vomiting, constipation, dry mouth, sweating, itching, confusion, mood changes.

Serious: seizures, serotonin syndrome (with antidepressants), breathing depression (with sedatives/alcohol), low blood sugar, low sodium, dependence and withdrawal, liver damage (paracetamol overdose).

• May cause dependence — do not use longer than needed; taper after regular use.
• Do not drive if drowsy; avoid alcohol completely.
• History of seizures, head injury, depression, substance misuse: caution.
• Some people are ultra-rapid metabolisers of tramadol (higher risk of toxicity).

Not recommended in pregnancy (withdrawal in the newborn) or during breastfeeding.

• SSRIs, SNRIs, tricyclics, MAO inhibitors, triptans, linezolid (serotonin syndrome, seizures)
• Benzodiazepines, alcohol, other opioids, sedating antihistamines (breathing depression)
• Carbamazepine (reduces tramadol effect)
• Warfarin (raised INR)
• Ondansetron (reduced pain relief)
• Bupropion (seizures)

Emergency: tramadol — pinpoint pupils, vomiting, seizures, slow breathing, coma; paracetamol — liver damage developing over 1–3 days even if the person feels well. Go to hospital immediately (naloxone and acetylcysteine may be needed).

Store below 30°C, out of reach of children.