Patram is a Schedule 5 tablet combining tramadol 37.5 mg with paracetamol 325 mg. It is used for moderate to severe pain where paracetamol alone is not enough — after surgery or injury, dental pain, back pain and some chronic pain. Tramadol is an opioid, and that governs almost everything about how this tablet should be used.

What is Patram?

The South African Medicine Price Registry lists Patram 37.5 mg/325 mg as a Schedule 5 tablet containing tramadol hydrochloride 37.5 mg and paracetamol 325 mg.

Schedule 5 means prescription-only, with controlled-substance record-keeping. That reflects tramadol’s dependence potential, and it is the most important thing to know about this tablet.

The two ingredients relieve pain by different routes, which is why the combination works better than either alone:

Paracetamol acts mainly in the central nervous system to reduce the perception of pain. It works within about half an hour and has little effect on inflammation.

Tramadol is an atypical opioid with two mechanisms. It binds weakly to opioid receptors — considerably more weakly than morphine or codeine — and it also blocks the reabsorption of serotonin and noradrenaline in the spinal cord, strengthening the body’s own pain-damping pathways. That second mechanism is why it works reasonably well for nerve pain, where conventional opioids often disappoint, and it is also why tramadol interacts with antidepressants in a way other opioids do not.

Tramadol depends on your liver to work. The enzyme CYP2D6 converts it into a far more active form, and people vary enormously in it. Roughly 5 to 10 per cent convert it poorly and get little opioid effect — “tramadol doesn’t work for me” is often literally true. A smaller group convert it unusually fast and get an unexpectedly strong effect, which is why tramadol is not given to children and is avoided in breastfeeding.

Combining the two lets each stay at a modest dose — 37.5 mg is a low tramadol dose — while giving relief comparable to a higher dose of either.

The same combination is sold as Painogesic Co, Tramacet and others. See Painogesic, whose plain version is paracetamol alone — the two are easily confused.

What is Patram commonly used for?

Moderate to severe acute pain where paracetamol or an anti-inflammatory alone is not enough.
Pain after surgery, including dental extraction.
Pain after injury — fractures, significant sprains, soft tissue injury.
Acute back pain, for short courses.
Osteoarthritis pain, where anti-inflammatories are unsuitable or insufficient.
Some chronic and nerve pain, though long-term opioid use for chronic non-cancer pain is now approached far more cautiously.
Cancer pain, as a step on the analgesic ladder.

It is intended for short courses. Tramadol causes tolerance — the same dose does less over time — and physical dependence develops within weeks of regular use. The evidence that opioids help chronic non-cancer pain long term is weak, while the evidence of harm is strong, and prescribing has shifted accordingly. If you are taking it beyond a few weeks, that deserves a review rather than a repeat.

Do not stop abruptly after regular use. Tramadol withdrawal causes anxiety, sweating, insomnia, nausea, tremor, aches and, unusually among opioids, sometimes confusion and hallucinations. Reduce gradually with your doctor.

How Patram fits into this medicine category

Group	Examples	Notes
Simple analgesics	Paracetamol (Donapan)	Pain and fever; safest
NSAIDs	Ibuprofen, diclofenac	Also reduce inflammation; stomach, kidney, heart cautions
NSAID + paracetamol	Mypaid Forte	Two mechanisms, no opioid
Weak opioid + paracetamol	Patram, Painogesic Co, Synaleve, Stopayne	Stronger; dependence risk
Strong opioids	Morphine, oxycodone, fentanyl	Severe pain; specialist use
Corticosteroids	Prednisone	Powerful anti-inflammatory, in courses
Nerve pain agents	Pregabalin, amitriptyline	For nerve pain specifically

Before an opioid combination, it is worth asking whether a non-opioid one would do. An ibuprofen-and-paracetamol tablet gives good relief for many kinds of pain without dependence, constipation or rebound headache — and for dental and post-operative pain the evidence is genuinely strong.

See the pain, inflammation and musculoskeletal medicines hub.

What to check before using Patram

Do not take other paracetamol products alongside it. Paracetamol is in cold and flu sachets and tablets, sinus preparations, some cough mixtures, and other compound painkillers. Taking any of those with Patram means taking paracetamol twice — the commonest route to serious accidental overdose, which damages the liver without early symptoms.

The interactions that matter most:

Antidepressants — SSRIs, SNRIs, tricyclics, mirtazapine, and especially MAOIs, which must not be combined. Tramadol’s serotonin effect adds to theirs, raising the risk of serotonin syndrome and of seizures. This is the most clinically important interaction and it is common, since many people taking Patram also take an antidepressant.
Other opioids, benzodiazepines, sleeping tablets, pregabalin or gabapentin. Combined, these can cause dangerously slowed breathing. Deaths have occurred from exactly these combinations.
Alcohol, for the same reason.
Carbamazepine, which reduces tramadol’s effect substantially.
Warfarin, where bleeding risk may rise.

Also tell your doctor if you:

Have epilepsy or any history of seizures. Tramadol lowers the seizure threshold.
Have breathing problems, COPD or sleep apnoea.
Have liver disease or kidney disease.
Have a head injury or raised pressure in the head.
Have a history of substance dependence.
Have depression or are at risk of self-harm.
Are elderly, where sedation, confusion and falls are more likely.
Are pregnant or breastfeeding. Tramadol is avoided in breastfeeding because of the ultra-rapid converter risk to the baby.
Weigh under 50 kg, or are malnourished — both reduce the safe paracetamol maximum.

Practical points:

Do not drive until you know how it affects you.
Follow the pack instructions for how much and how often, and the 24-hour maximum. This page does not set doses.
Take the lowest dose that works, for the shortest time.
Expect constipation and manage it early — fluid, fibre, and a laxative if needed.
Do not stop suddenly after regular use.

Possible cautions and when to ask a pharmacist or doctor

Common effects: nausea, vomiting, dizziness, drowsiness, constipation, dry mouth, sweating and headache. Nausea and dizziness are common early and often settle.

Get emergency help for:

Any suspected overdose, even if the person seems well. Take the packaging. Paracetamol damages the liver silently, and the antidote works best given early.
Slow or shallow breathing, or difficulty waking someone.
A seizure.
Agitation with fever, sweating, shivering, muscle twitching, fast heartbeat and confusion — possible serotonin syndrome.
Swelling of the face, lips or tongue, or difficulty breathing.
A widespread blistering or peeling rash.

Seek prompt advice for:

Confusion, hallucinations or marked drowsiness.
Persistent constipation.
New or worsening low mood, or thoughts of self-harm.
A rash or itching.
Finding yourself taking more than prescribed, or wanting to. This is worth raising early rather than late, and it is a common experience with tramadol, not a personal failing.

Contact your doctor if pain is not controlled, if you have been taking it more than a couple of weeks, if you want to stop — so it can be tapered — or if the pain is severe, worsening, or comes with fever, weight loss, numbness, weakness or loss of bladder or bowel control.

Related medicine guides

Frequently asked questions

What are Patram tablets used for? Moderate to severe pain — after surgery or injury, dental pain, back pain and some chronic pain. Each tablet contains tramadol 37.5 mg with paracetamol 325 mg.

Is Patram an opioid? Yes, in part. Tramadol is an atypical opioid, weaker than morphine or codeine, but it can cause dependence and is Schedule 5.

Why two medicines in one tablet? They relieve pain by different mechanisms, so together they work better than either alone at the same doses.

Can I take Panado with it? No. Patram already contains paracetamol. Taking both means taking paracetamol twice.

Can I take it with my antidepressant? Only if your doctor has decided so deliberately. Tramadol combined with antidepressants raises the risk of serotonin syndrome and seizures.

Why does it not work for me? Tramadol has to be converted by a liver enzyme to become strongly active, and roughly 5 to 10 per cent of people convert it poorly. “It doesn’t work for me” is often literally true.

Is it addictive? It can cause tolerance and dependence with regular use. Take only what is prescribed, and tell your doctor if you feel you need more.

Can I stop suddenly? No. Tramadol withdrawal causes anxiety, sweating, insomnia, nausea and tremor. Reduce gradually with your doctor.

Can I drink alcohol with it? No. The combination can cause dangerously slowed breathing.

What Is Patram Used For?