May cause drowsiness—avoid driving/operating machinery. Risk of dependence, misuse and withdrawal with tramadol. Do not use with other paracetamol-containing products; overdose can cause severe liver damage. Use caution in liver or kidney disease, elderly, head injury, respiratory disease/asthma, history of seizures, and in patients at risk of serotonin syndrome. Avoid in severe respiratory depression or acute alcohol/other CNS depressant intoxication. Seek urgent help for slow/shallow breathing, severe sleepiness, allergic reactions, or signs of liver injury (yellowing of skin/eyes, dark urine).
