It’s my understanding that not all Tramadol contains Acetaminophen. If it does, it’s vital to monitor usage closely, and to avoid an overdose (which doesn’t take much) and alcohol.
From addictionblog.org:
No, Tramadol does not contain acetaminophen.
In fact, generic tramadol hydrochloride is one option doctors prescribe often for pain relief because it is both efficient and less addictive. We review tramadol combinations and risks of taking acetaminophen here.
Brand Names That Contain Tramadol
ER = (extended release)
* = (contains acetaminophen)
Ryzolt
Ultracet *
Ultram
Ultram ER
BE AWARE: Ultracet (a brand name version of tramadol), combines both tramadol and acetaminophen.
Tramadol Hydrochloride And Acetaminophen Together For Pain
Tramadol/acetaminophen combination tablets are generally effective for the treatment of pain without any serious adverse effects. Tramadol efficacy depends on your general health, age, and dosing details. But if you want to avoid the combination, avoid ULTRACET.
Acetaminophen Dangers
While acetaminophen is generally safe for short term use, there are some special considerations when considering this medicine for pain relief. First, you should not to exceed the FDA acetaminophen maximum total daily dose (4 grams/day). If you take acetaminophen over a long period of time or take it in higher than recommended doses, liver and kidney damage can result, as well as bleeding from the small and large intestines and the stomach. Large doses of acetaminophen are the main risk, but liver problems have been reported after small to moderate dosing of acetaminophen for long periods of time.
Additionally, doctors warn that you avoid alcohol while taking acetaminophen-containing medications. This is because alcohol and acetaminophen can lead to a life threatening complications called “alcohol acetaminophen syndrome” which cause acute liver failure. Although there is no official threshold for alcohol and acetaminophen, experts recommend that heavy drinkers shouldn’t take more than 2 grams of acetaminophen daily.
We didn’t find out for quite a while that the generic tramadol contained acetaminophen. Dad was on so many meds that I finally bought a pill book to keep up. The 11th edition was from 2004. It listed Generic Tramadol as having both Tramadol and Acetaminophen combined.
So I went back and double checked with my Doctor and Pharmacist and they confirmed it. So I had to take that into consideration as part of his Tylenol dose, which had to be more limited than usual due to his kidneys.
I know there were news reports that people were inadvertently getting too much and damaging kidneys and livers, because the disclosures weren't clear enough, and elderly people especially have to be careful with acetaminophen.
Bottom line is to be careful and ask a lot of questions when you get pain meds. Sorry to get into the weeds with all the detail.LOL