Ultracet combines tramadol 37.5 mg with paracetamol 325 mg in one tablet. It is prescribed for moderate to severe short-term pain — after surgery or dental work, and for acute musculoskeletal pain. It contains an opioid, and it is meant for short, defined courses.
What is Ultracet?
Ultracet is a Schedule 5 tablet listed in the South African Medicine Price Registry containing:
| Ingredient | Amount |
|---|---|
| Tramadol hydrochloride | 37.5 mg |
| Paracetamol | 325 mg |
Schedule 5 means prescription-only and subject to tighter control than an ordinary Schedule 4 medicine, reflecting the tramadol.
The combination exists for a specific reason, and it is a sound one. Tramadol and paracetamol relieve pain by different mechanisms:
Paracetamol acts centrally to reduce the perception of pain, and starts working within about half an hour.
Tramadol is a weak opioid acting on opioid receptors, and it also increases serotonin and noradrenaline in the spinal cord — the same neurotransmitters some antidepressants act on. It takes longer to reach full effect but lasts longer.
Together they give faster onset and longer duration than either alone, and the fixed low dose of tramadol means less opioid is used than with tramadol on its own. The dual serotonin and noradrenaline action also explains several of the interactions below.
The tramadol dose here is deliberately low. 37.5 mg is a fraction of what a plain tramadol capsule contains — this is a step below standalone tramadol, not above it.
The same combination is sold under other names in South Africa, including Dytracet and Tramacet. Being given one instead of another is ordinary substitution.
What is Ultracet commonly used for?
- Moderate to severe acute pain, short-term.
- Pain after surgery, including dental extraction.
- Acute musculoskeletal pain — back and neck pain, after injury.
- Osteoarthritis pain, where anti-inflammatories are unsuitable or insufficient.
- Pain not controlled by paracetamol or an anti-inflammatory alone.
- Short-term flares of chronic pain, on medical direction.
It sits deliberately in the middle of the pain ladder: stronger than paracetamol or ibuprofen, weaker than standalone tramadol or a strong opioid.
It is not a long-term answer to chronic pain. Evidence for lasting benefit in ongoing non-cancer pain is weak, while the risks of dependence, tolerance and side effects accumulate steadily with time.
Two limits matter more than any of the indications:
Do not take other paracetamol with it. Ultracet already contains 325 mg per tablet. Cold and flu remedies, sinus products and other painkillers frequently contain paracetamol, and taking one alongside Ultracet means taking paracetamol twice — the most common route to serious accidental overdose.
Do not take other tramadol or codeine with it. Doubling up on opioids raises the risk of dangerously slowed breathing.
How Ultracet fits into this medicine category
| Step | Examples | Where it fits |
|---|---|---|
| Simple analgesics | Paracetamol (Donapan) | Mild pain and fever |
| Anti-inflammatories | Ibuprofen, diclofenac | Pain with inflammation |
| Weak opioid combinations | Ultracet, Dytracet, Tramacet | Moderate pain; less opioid than tramadol alone |
| Weak opioids | Tramadol, codeine | Moderate to severe pain |
| Strong opioids | Morphine, oxycodone | Severe pain, supervised |
| Corticosteroids | Prednisone | Inflammatory conditions, in courses |
See the pain, inflammation and musculoskeletal medicines hub.
What to check before using Ultracet
Do not combine it with alcohol. Both suppress breathing and consciousness, and together the risk is substantially greater than either alone.
Tell your doctor or pharmacist if you:
- Take an antidepressant — SSRIs, SNRIs, tricyclics — triptans for migraine, or St John’s wort. Combining these with tramadol can cause serotonin syndrome, and this is one of the most important interactions in everyday prescribing.
- Take benzodiazepines, sleeping tablets, gabapentin or pregabalin, or other sedating medicines. The combination with an opioid significantly raises the risk of dangerously slowed breathing.
- Have epilepsy or a history of seizures. Tramadol lowers the seizure threshold.
- Have liver disease — relevant to both ingredients — or kidney disease.
- Have breathing problems, particularly sleep apnoea or severe COPD.
- Have a history of dependence on opioids, alcohol or other substances.
- Weigh under 50 kg, or are malnourished — both lower the safe paracetamol threshold.
- Are pregnant or breastfeeding.
- Are elderly, where dose reductions and a higher risk of falls and confusion apply.
Do not drive until you know how it affects you. Drowsiness and slowed reactions are expected.
Follow the prescribed dose exactly, and note the daily maximum — with paracetamol in the tablet, exceeding it matters more than with most painkillers. This page does not set doses.
Possible cautions and when to ask a pharmacist or doctor
Common effects include nausea, vomiting, dizziness, drowsiness, dry mouth, constipation and sweating. Nausea is frequent early and often settles; constipation tends not to, and is worth managing from the start with fluid, fibre and, if needed, a laxative.
Get emergency help for:
- Suspected paracetamol overdose. This is the most dangerous scenario and the least obvious — someone who has taken too much may feel entirely well for a day or more while serious liver damage develops. Go to an emergency department immediately with the packaging, even if they seem fine and even if it was accidental. There is an effective antidote and it works best given early.
- Very slow, shallow or difficult breathing, extreme drowsiness or unresponsiveness — signs of opioid overdose.
- Seizures.
- Serotonin syndrome — agitation, confusion, fever, sweating, shivering, muscle twitching or a racing heart, especially after starting another serotonergic medicine.
- Swelling of the face, lips or tongue, difficulty breathing, or a blistering rash.
Dependence and withdrawal are real. Taken regularly beyond a short period, the body adapts, and stopping abruptly can cause anxiety, sweating, insomnia, tremor, nausea and flu-like symptoms. If you have been taking it regularly, ask your doctor to plan a gradual reduction rather than stopping on your own.
Contact your doctor if pain is not controlled, if you find yourself needing more than prescribed, if drowsiness is interfering with daily life, or if the course is ending without a plan for what follows.
Related medicine guides
- Browse Pain, Inflammation & Musculoskeletal Medicines guides
- Read: Prednisone used for
- Read: Donapan used for
Frequently asked questions
What is Ultracet used for? Moderate to severe short-term pain — after surgery or dental work, acute back and musculoskeletal pain, and pain not controlled by paracetamol or an anti-inflammatory alone.
What is in it? Tramadol 37.5 mg and paracetamol 325 mg.
Why combine two painkillers? They work by different mechanisms, giving faster onset and longer duration than either alone — and the low tramadol dose means less opioid is used.
Is it stronger than tramadol? No. The tramadol dose is a fraction of a standalone capsule. It is a step below plain tramadol, not above it.
Can I take paracetamol with it? No. It already contains paracetamol, and doubling up is the commonest route to serious accidental overdose. Check every other product you take.
Is it addictive? It contains tramadol, an opioid, and regular use causes dependence. Do not stop abruptly after regular use — ask for a gradual reduction.
Can I drink alcohol on it? No. The combination dangerously suppresses breathing.
Can I take it with my antidepressant? Tell your doctor. Combining tramadol with serotonergic medicines raises the risk of serotonin syndrome.