Tramacet (Tramadol/Acetaminophen) Dosing Recommendations
The recommended dosing for Tramacet (tramadol/acetaminophen) is 1-2 tablets (37.5 mg tramadol/325 mg acetaminophen per tablet) every 4-6 hours as needed for pain, with a maximum daily dose of 8 tablets (300 mg tramadol/2600 mg acetaminophen) per day. 1, 2
Standard Dosing Protocol
- Initial dose: 1-2 tablets (37.5 mg tramadol/325 mg acetaminophen per tablet) every 4-6 hours as needed
- Maximum daily dose: 8 tablets per day (300 mg tramadol/2600 mg acetaminophen)
- Typical daily usage: 4-4.5 tablets per day for both acute and chronic pain conditions 3
Special Population Considerations
Hepatic Impairment
- Reduce dose or avoid in patients with hepatic impairment
- Maximum acetaminophen component should not exceed 2-3 g daily in patients with liver disease 4
- Consider alternative analgesics in severe hepatic impairment
Renal Impairment
- Reduce dose in patients with renal dysfunction
- Bioavailability of tramadol may increase 2-3 fold in patients with cirrhosis 4
- For patients with cirrhosis: no more than 50 mg tramadol within 12 hours 4
Elderly Patients (≥75 years)
- Lower doses recommended to reduce risk of seizures and other adverse effects 4
- Start at the lower end of the dosing range
Important Drug Interactions and Precautions
Contraindications
- Do not use with MAOIs due to risk of serotonin syndrome 4
- Avoid in patients taking SSRIs, SNRIs, or TCAs due to increased risk of serotonin syndrome 4
Monitoring Requirements
- Monitor for signs of opioid toxicity
- Watch for signs of serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, excessive sweating, shivering, tremors)
- Regular assessment of pain control and adverse effects
Efficacy Considerations
- Onset of action is approximately 17 minutes, faster than tramadol alone (51 minutes) 1
- The combination provides better pain relief with fewer adverse events than either component separately 1
- Most effective for mild to moderate pain 1
- Fixed combination allows for 25% less tramadol while maintaining efficacy, reducing tramadol-related adverse events 1
Common Side Effects
- Nausea and vomiting (dose-dependent)
- Dizziness
- Constipation
- Drowsiness
- Headache
Clinical Pearls
- Reducing the loading dose during the first days of treatment significantly improves tolerability 5
- The combination is particularly useful when acetaminophen alone is inadequate for pain control 3
- For breakthrough pain in cancer patients, tramadol alone can be dosed at 1-1.5 mg/kg every 4-6 hours 4
- Tramacet is considered a step 2 analgesic on the WHO pain ladder, appropriate for moderate pain before moving to strong opioids 5
By following these dosing guidelines and considering patient-specific factors, Tramacet can provide effective pain relief while minimizing adverse effects.