Combination of paracetamol and tramadol – facts and myths Review article
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Published:
Dec 31, 2024
Keywords:
multimodal analgesia, safety, compliance, paracetamol, hyperaddictive synergism, tramadol
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Abstract
Combining paracetamol and tramadol (analgesics with different mechanisms of action) effectively treats different types of pain. Reducing the doses of each drug allows for the same analgesic effect to be achieved as with monotherapy. Paracetamol is effective for receptor pain, while tramadol is effective for pain of a receptor, neuropathic and nociceptive nature. The action profiles of the two drugs are complementary, producing a hyperaddictive synergistic effect. In addition, the combination can be used in combination with other analgesics and co-analgesics as part of multimodal therapy. Tramadol and paracetamol is used in patients in whom non-steroidal anti-inflammatory drugs are contraindicated and in patients over 65 years of age.
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How to Cite
Kocot-Kępska, M. (2024). Combination of paracetamol and tramadol – facts and myths. Medycyna Faktow (J EBM), 17(4(65), 516-522. https://doi.org/10.24292/01.MF.0424.13
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References
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2. Chou R, Gordon DB, de Leon-Casasola OA et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016; 17(2): 131-57. http://doi.org/10.1016/j.jpain.2015.12.008.
3. Ito H. What Should We Do to Improve Patients’ Adherence? J Exp Clin Med. 2013; 5: 127-30.
4. Mallet C, Desmeules J, Pegahi R et al. An Updated Review on the Metabolite (AM404)-Mediated Central Mechanism of Action of Paracetamol (Acetaminophen): Experimental Evidence and Potential Clinical Impact. J Pain Res. 2023; 16: 1081-94. http://doi.org/10.2147/JPR.S393809.
5. Barakat A. Revisiting Tramadol: A Multi-Modal Agent for Pain Management. CNS Drugs. 2019; 33(5): 481-501. http://doi.org/10.1007/s40263-019-00623-5.
6. Schug SA, Palmer GM, Scott DA et al.; APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Acute Pain Management: Scientific Evidence (5th edition), ANZCA & FPM, Melbourne 2020.
7. Australian Public Assessment Report for Tramadol hydrochloride/Paracetamol.
8. Cao Z, Han K, Lu H et al. Paracetamol Combination Therapy for Back Pain and Osteoarthritis: A Systematic Review and Meta-Analyses. Drugs. 2024; 84(8): 953-67. http://doi.org/10.1007/s40265-024-02065-w .
9. Wiffen PJ, Derry S, Moore RA. Tramadol with or without paracetamol (acetaminophen) for cancer pain. Cochrane Database Syst Rev. 2017; 5(5): CD012508. http://doi.org/10.1002/14651858.CD012508.pub2.
10. Chaparro LE, Wiffen PJ, Moore RA et al. Combination pharmacotherapy for the treatment of neuropathic pain in adults. Cochrane Database Syst Rev. 2012; 2012(7): CD008943. http://doi.org/10.1002/14651858.CD008943.pub2.
11. Lee EY, Lee EB, Park BJ et al. Tramadol 37.5-mg/acetaminophen 325-mg combination tablets added to regular therapy for rheumatoid arthritis pain: a 1-week, randomized, double-blind, placebo-controlled trial. Clin Ther. 2006; 28(12): 2052-60. http://doi.org/10.1016/j.clinthera.2006.12.019.
12. Alwine L. Long-term (2-year) analgesic efficacy of tramadol/acetaminophen tablets In: European League Against Rheumatism (EULAR) Congress; 2000; 2000. p. Poster 301.
13. Raffa RB. Pharmacology of oral combination analgesics: rational therapy for pain. J Clin Pharm Ther. 2001; 26: 257-64.
14. Pickering G, Kotlińska-Lemieszek A, Krcevski Skvarc N et al. Pharmacological Pain Treatment in Older Persons. Drugs Aging. 2024; 41(12): 959-76. http://doi.org/10.1007/s40266-024-01151-8.
15. Charakterystyka Produktu Leczniczego, Poltram Combo, Tabletki powlekane, 37,5 mg + 325 mg.
16. Stępień A, Kozubski W, Rożniecki J et al. Leczenie migreny. Zalecenia opracowane przez grupę ekspertów Polskiego Towarzystwa Bólów Głowy, Polskiego Towarzystwa Badania Bólu i Sekcji Badania Bólu Polskiego Towarzystwa Neurologicznego. BÓL. 2020; 21(2): 11-30. http://doi.org/10.5604/01.3001.0014.4591.
17. Lapeyre-Mestre M, Bertin C, Jalles C et al. Monitoring opioid analgesic misuse, abuse and dependence: What to the data from addictovigilance tell us about the situation in France? Therapie. 2024: S0040-5957(24)00210-5. http://doi.org/10.1016/j.therap.2024.11.008.
18. Leki dostępne bez recepty i suplementy diety. Komunikat z Badań CBOS. 2016; 158: 1-20.
19. Kuerbis A, Sacco P, Blazer DG et al. Substance abuse among older adults. Clin Geriatr Med. 2014; 30(3): 629-54.
20. Motyl G, Krupka WM, Maślińska M. The problem of residual pain in the assessment of rheumatoid arthritis activity. Reumatologia. 2024; 62(3): 176-86. http://doi.org/10.5114/reum/189779.