Precautions for use: Tramadol HCl + Paracetamol (Tramadin Plus) should be used with caution in opioid dependent patients, or in patients with cranial trauma, in patients prone to convulsive disorder, biliary tract disorders, in a state of shock, in an altered state of consciousness for unknown reasons, with problems affecting the respiratory center or the respiratory function, or with an increased intracranial pressure. Paracetamol in over dosage may cause hepatic toxicity in some patients. At therapeutic doses, tramadol has the potential to cause withdrawal symptoms. Rarely, cases of dependence and abuse have been reported. Symptoms of withdrawal reactions, similar to those occurring during opiate withdrawal may occur. In one study, use of tramadol during general anesthesia with enflurane and nitrous oxide was reported to enhance intra-operative recall. Until further information is available, use of tramadol during light planes of anesthesia should be avoided.
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