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Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, pharmacist or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you have any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

This medicine contains tramadol hydrochloride which is an opioid, which can cause addiction. You can get withdrawal symptoms if you stop taking it suddenly.

What is in this leaflet:

1. What this medicine is and what it is used for
2. What you need to know before you take this medicine
3. How to take this medicine
4. Possible side effects
5. How to store this medicine
6. Contents of the pack and other information

Do not take this medicine:

• if you are allergic to tramadol, paracetamol or any of the other ingredients of this medicine (listed in section 6).
• in cases of acute alcohol poisoning.
• if you are taking sleeping pills, pain relievers or medicines that affect mood and emotions.
• if you are taking medicines called monoamine oxidase inhibitors (MAOIs) or if you have taken MAOIs in the last 14 days before treatment with this medicine. MAOIs are used in the treatment of depression or Parkinson’s disease.
• if you suffer from a severe liver disorder.
• if you suffer from epilepsy that is not adequately controlled by your current medicine.

Warnings and precautions

Talk to your doctor, pharmacist or nurse before taking this medicine:

• However if you are taking other medicines containing paracetamol or tramadol.
• if you have liver problems or disease as your eyes and skin may turn yellow, which may suggest jaundice.
• if you have kidney problems.
• if you have severe difficulties in breathing for example asthma or severe lung problems.
• if you have epilepsy or have already experienced fits or seizures.
• if you have recently suffered from a head injury, shock or severe headache associated with vomiting (being sick).
• if you are dependent on any medicine (for example morphine).
• if you are taking medicines to treat pain that contain buprenorphine, nalbuphine or pentazocine.
• if you suffer from depression and you are taking antidepressants as some of them may interact with tramadol (see ‘Other medicines and Tramadol/Paracetamol’).
• if you are going to have an anaesthetic (tell your doctor or dentist that you are taking this medicine).
• if you are or have ever been addicted to opioids, alcohol, prescription medicines, or illegal drugs.
• if you have previously suffered from withdrawal symptoms such as agitation, anxiety, shaking or sweating, when you have stopped taking alcohol or drugs.
• if you feel you need to take more of this medicine to get the same level of pain relief, this may mean you are becoming tolerant to the effects of this medicine or are becoming addicted to it. Speak to your prescriber who will discuss your treatment and may change your dose or switch you to an alternative pain reliever.

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There is a small risk that you may experience a so-called serotonin syndrome that can occur after having taken tramadol in combination with certain antidepressants or tramadol alone. Seek medical advice immediately if you have any of the symptoms related to this serious syndrome (see section 4 ‘Possible side effects’).

Taking this medicine regularly, particularly for a long time, can lead to addiction. Your prescriber should have explained how long you will be taking it for, and when it is appropriate to stop, how to do this safely.

Rarely, increasing the dose of this medicine can make you more sensitive to pain. If this happens, you need to speak to your prescriber about your treatment.

Addiction can cause withdrawal symptoms when you stop taking this medicine. Withdrawal symptoms can include restlessness, difficulty sleeping, irritability, agitation, anxiety, feeling your heartbeat (palpitations), increased blood pressure, feeling or being sick, diarrhoea, loss of appetite, shaking, shivering or sweating. Your prescriber will discuss with you how to gradually reduce your dose before stopping the medicine. It is important that you do not stop taking the medicine suddenly as you will be more likely to experience withdrawal symptoms.

Opioids should only be used by those they are prescribed for. Do not give your medicine to anyone else. Taking higher doses or more frequent doses of opioid, may increase the risk of addiction. Overuse and misuse can lead to overdose and/or death.

Moreover Tramadol is transformed in the liver by an enzyme. Some people have a variation of this enzyme and this can affect people in different ways. In some people, they may not get enough pain relief but other people are more likely to get serious side effects. If you notice any of the following side effects, you must stop taking this medicine and seek immediate medical advice: slow or shallow breathing, confusion, sleepiness, small pupils, feeling or being sick, constipation, lack of appetite.

Sleep-related breathing disorders

Also this medicine can cause sleep-related breathing disorders such as sleep apnoea (breathing pauses during sleep) and sleep related hypoxemia (low oxygen level in the blood). The symptoms can include breathing pauses during sleep, night awakening due to shortness of breath, difficulties to maintain sleep or excessive drowsiness during the day. If you or another person observe these symptoms, contact your doctor. A dose reduction may be considered by your doctor.

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Talk to your doctor if you experience any of the following symptoms while taking Tramadol/Paracetamol:

Extreme fatigue, lack of appetite, severe abdominal pain, nausea, vomiting or low blood pressure. This may indicate that you have adrenal insufficiency (low cortisol levels). If you have these symptoms, contact your doctor, who will decide if you need to take hormone supplement.

If any of the above-mentioned points applied to you in the past or applies to you while you are taking this medicine, please make sure your doctor knows. He/she can then decide whether you should continue to use this medicine.

Other medicines and Tramadol/Paracetamol

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Do not exceed the maximum daily doses of paracetamol or tramadol from this or other medicines.

Do not take this medicine with MAOIs (see section “Do not take this medicine”).

Please inform your doctor or pharmacist if you are taking:

• flucloxacillin (antibiotic), due to a serious risk of blood and fluid abnormality (high anion gap metabolic acidosis) that must have urgent treatment and which may occur particularly in case of severe renal impairment, sepsis (when bacteria and their toxins circulate in the blood leading to organ damage), malnutrition, chronic alcoholism, and if the maximum daily doses of paracetamol are used.

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• Carbamazepine (a medicine used to treat epilepsy or some types of pain)
• Buprenorphine, nalbuphine or pentazocine (opioid-type pain killers)

The risk of side effects increases:

• However if you are taking triptans (used for migraine) or selective serotonin re-uptake inhibitors (SSRIs, used for depression). Check with your doctor if you experience confusion, restlessness, fever, sweating, uncoordinated movement of limbs or eyes, uncontrollable jerking of muscles or diarrhoea.
• if you are taking other pain relievers such as morphine and codeine (also as cough medicine), baclofen (a muscle relaxant), medicines used to lower blood pressure, or medicines to treat allergies. Check with your doctor if you feel drowsy or feel faint.
• concomitant use of Tramadol/Paracetamol and sedative medicines such as benzodiazepines or related drugs increases the risk of drowsiness, difficulties in breathing (respiratory depression), coma and may be life threatening. Because of this, concomitant use should only be considered when other treatment options are not possible. However if your doctor does prescribe Tramadol/Paracetamol together with sedative medicines the dose and duration of concomitant treatment should be limited by your doctor. Please tell your doctor about all sedative medicines you are taking, and follow your doctor’s dose recommendation closely. It could be helpful to inform friends or relatives to be aware of the signs and symptoms stated above. Contact your doctor when experiencing such symptoms.
• if you are taking medicines which may cause convulsions (fits), such as certain antidepressants or antipsychotics. The risk of having a fit may increase if you take this medicine at the same time. Your doctor will tell you whether this medicine is suitable for you.
• if you are taking certain antidepressants. This medicine may interact with these medicines and you may experience serotonin syndrome (see section 4 ‘Possible side effects’).
• if you are taking warfarin or phenprocoumon (for blood thinning). The effectiveness of such medicines may be altered and bleeding may occur (see section 4).

The effectiveness of this medicine may be altered if you also take the following medicines:

• Metoclopramide, domperidone and ondansetron (medicines used to treat nausea and vomiting/being sick).
• Cholestyramine (medicine used to reduce cholesterol in blood). 325mg TRAMADOL For Sale Online

This medicine with food and alcohol