Tramacet (Tramadol/Acetaminophen) Prescription Guidelines
For adults with moderate to moderately severe pain, Tramacet should be prescribed at a starting dose of 1-2 tablets (37.5 mg tramadol/325 mg acetaminophen per tablet) every 4-6 hours as needed, not exceeding 8 tablets (400 mg tramadol) per day. 1, 2
Dosing Recommendations
- Initial dosing should start with 1 tablet (37.5 mg tramadol/325 mg acetaminophen) every 4-6 hours, which can be increased to 2 tablets per dose if needed for adequate pain control 2, 3
- Maximum daily dose should not exceed 8 tablets in 24 hours (equivalent to 300 mg tramadol/2600 mg acetaminophen) 1, 4
- For elderly patients over 75 years, total daily tramadol dose should not exceed 300 mg 1
- For improved tolerability, especially in opioid-naïve patients, consider starting with a lower dose and titrating upward 1, 5
Special Populations
- Renal impairment: For patients with creatinine clearance <30 mL/min, increase dosing interval to 12 hours with maximum daily dose of 200 mg tramadol 1
- Hepatic impairment: For patients with cirrhosis, reduce dose to 50 mg tramadol every 12 hours 1, 6
- Elderly patients: Start at the lower end of the dosing range; for patients >75 years, total daily dose should not exceed 300 mg tramadol 1
- Dialysis patients: Regular dose can be administered on dialysis days as only 7% of tramadol is removed by hemodialysis 1
Clinical Considerations
- Tramacet is typically used for moderate pain when acetaminophen or NSAIDs alone are inadequate 6, 2
- The combination provides better analgesia than either component alone, with faster onset than tramadol alone and longer duration than either agent as monotherapy 4, 2
- Studies show that the most common effective dosing regimen is 3.5-4.5 tablets per day for both acute and chronic pain conditions 3
- For chronic pain, tramadol/acetaminophen may be used for up to 3 months to decrease pain and improve function, particularly in conditions like osteoarthritis 6, 2
Prescription Writing Format
When writing a Tramacet prescription, include:
- Patient's full name, address, and date of birth
- Medication name: "Tramacet" or "Tramadol/Acetaminophen 37.5/325 mg tablets"
- Dosage: "1-2 tablets"
- Frequency: "Every 4-6 hours as needed for pain"
- Maximum daily dose: "Not to exceed 8 tablets in 24 hours"
- Quantity: Appropriate for duration of treatment (e.g., "Dispense 40 tablets")
- Refills: As clinically appropriate
Important Precautions
- Monitor for signs of serotonin syndrome if patient is taking SSRIs, SNRIs, or tricyclic antidepressants 6
- Risk of seizures increases if used in high doses or in predisposed patients 6
- Tramadol has dual mechanisms of action: weak μ-opioid receptor agonist and inhibition of norepinephrine/serotonin reuptake 5
- While tramadol has lower abuse potential than traditional opioids, it still carries risk of dependence 5, 7
- Avoid abrupt discontinuation after prolonged use to prevent withdrawal symptoms 5
Common Pitfalls to Avoid
- Exceeding maximum acetaminophen dose (4000 mg/day), especially in patients with liver disease 6
- Failure to adjust dosing in elderly patients or those with renal/hepatic impairment 1
- Drug interactions with serotonergic medications can increase risk of serotonin syndrome 6
- Not accounting for the ceiling effect of tramadol at doses above 400 mg/day 6, 1
- Prescribing for long-term use without reassessing efficacy and side effects 6