Tramadol should be used with caution when administered to patients taking CNS depressants such as: Alcohols, opioids, narcotics, sedatives, phenothiazines, hypnotics, antihistamines, neuroleptics, centrally acting antihypertensive drugs. These drugs may increase the risk of CNS and respiratory depression.
Convulsion have been reported in tramadol-treated patients susceptible to seizures or taking other medications that lower the seizure threshold especially SSRIs, tricyclic antidepressants, antipsychotics and other opioids.
If tramadol is discontinued abruptly, symptoms of withdrawal reactions may occur which include: Anxiety, sweating, insomnia, pain, nausea, tremors, diarrhea, respiratory tract infection, keratosis pilaris, agitation, nervousness, hyperkinesias and gastrointestinal symptoms. Panic attacks, hallucinations, paresthesia, and unusual CNS symptoms have rarely been reported.
Tramadol should be used with caution in patients with hepatic or renal impairment, history of epilepsy or those susceptible to seizures.
Paracetamol should be given with care to patients with impaired kidney and liver function. It should also be given with care to patients with alcohol dependence.
Overdosage of paracetamol may increase hepatic toxicity to patients with chronic alcoholism.
Effects on Ability to Drive and Operate Machines: May impair mental or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery.