tramadol and acetaminophen, Ultracet (cont.)

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PRESCRIBED FOR: Ultracet is used to for the short-term (up to five days) relief of moderately-severe, acute pain.

DOSING: The usual dose of Ultracet is two tablets every four to six hours as needed for the relief of pain. Patients should not take more than two tablets at a time nor more than 8 tablets per day.

DRUG INTERACTIONS: Carbamazepine (Tegretol) or rifampin can increase the rate of metabolic breakdown of tramadol, thus making tramadol less effective. Concomitant administration of quinidine, fluoxetine (Prozac), paroxetine (Paxil) and amitriptyline (Elavil, Endep), ketoconazole (Nizoral, Extina, Xolegel, Kuric), or erythromycin may reduce elimination of tramadol, increasing the risk for serious side effects from tramadol.

Combining tramadol with monoamine oxidase inhibitors (for example, Parnate), selective serotonin inhibitors (SSRIs, for example, fluoxetine [Prozac]), linezolid (Zyvox), St. John's wort, triptans (for example sumatriptan [Imitrex, Alsuma]) may result in severe side effects such as seizures or a condition called serotonin syndrome. Tramadol may increase central nervous system and respiratory depression when combined with alcohol, anesthetics, narcotics, tranquilizers, or sedative hypnotics.

PREGNANCY: Safe use during pregnancy has not been established. There have been reports of neonatal seizures, neonatal withdrawal syndrome, fetal death and stillbirth.

NURSING MOTHERS: Tramadol is excreted in breast milk. Safe use in nursing mothers has not been established.



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