Does tramadol contain acetaminophen (Tylenol)?

Does Tramadol Contain Acetaminophen (Tylenol)?

Tramadol does NOT inherently contain acetaminophen—it is available both as a single-ingredient medication and as a fixed-dose combination product with acetaminophen. 1

Understanding Tramadol Formulations

Single-Ingredient Tramadol

• Pure tramadol hydrochloride tablets contain only tramadol as the active ingredient, typically in 50 mg strength, along with inactive ingredients like hypromellose, lactose monohydrate, and magnesium stearate 1
• Tramadol alone is a centrally acting weak mu-opioid receptor agonist with norepinephrine and serotonin reuptake inhibition properties 2
• Available as both immediate-release (IR) and extended-release (ER) formulations without any acetaminophen 2

Combination Product: Tramadol/Acetaminophen

• A fixed-dose combination product exists containing tramadol 37.5 mg combined with acetaminophen 325 mg per tablet 3, 4
• This combination product uses 25% less tramadol than standard single-ingredient tablets, which reduces tramadol-related adverse events while the acetaminophen component reduces onset time of analgesia and improves the degree of pain relief 4
• The combination provides faster onset of action (17 minutes) compared to tramadol alone (51 minutes) and longer duration than acetaminophen alone 4

Clinical Implications

Prescribing Considerations

• Always verify which formulation is being prescribed or dispensed—the single-ingredient tramadol versus the combination product 3
• When using the combination product, maximum daily dosing must account for both components: do not exceed 400 mg of tramadol (or 300 mg for ER formulations) 3, 5
• The acetaminophen component in combination products adds hepatotoxicity risk, particularly important in patients with hepatic dysfunction or those taking other acetaminophen-containing products 6

Dosing Differences

• Single-ingredient tramadol: typically 50-100 mg every 4-6 hours, maximum 400 mg/day for IR or 300 mg/day for ER 2, 5
• Combination product: typically 2 tablets (75 mg tramadol/650 mg acetaminophen) every 4-6 hours as needed 7
• Elderly patients (≥75 years) and those with hepatic or renal dysfunction require mandatory dose reductions regardless of formulation 3, 5

Common Pitfall

• Do not assume all tramadol prescriptions contain acetaminophen—this is a frequent source of medication errors and can lead to either inadequate pain control (if combination product expected but single-ingredient given) or acetaminophen overdose (if patients take additional acetaminophen products thinking their tramadol is acetaminophen-free) 6