Supplements and Tramadol with paracetamol.
Tramadol with paracetamol, sold under the brand name Tramacet, is an opioid analgesic.
Tramadol with paracetamol is an opioid analgesic. The class binds primarily to mu receptors, producing analgesia, sedation, respiratory depression at high doses, and a documented dependence profile. UK primary care prescribing has shifted substantially since the early 2010s away from chronic opioid use for non-cancer pain. The shift follows Faculty of Pain Medicine and NHS England stewardship guidance. The supplement surface includes three patterns. Additive CNS depression (alcohol, benzodiazepines, kava, valerian at higher doses, magnesium glycinate at high doses at bedtime). Constipation amplification (almost universal with chronic opioid use). And serotonergic concerns for the more serotonergic opioids when combined with SSRIs, SNRIs, MAOIs, 5-HTP, or rhodiola. Tramadol is the textbook example for the serotonergic concern, with pethidine to a lesser extent. The BNF and MHRA flag the combination.
Below are the 3 documented pairs we have explicitly assessed against Tramadol with paracetamol in the Distil database: 1 severe and 2 caution. The pairs cluster around 1 mechanism: Additive serotonergic activity. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.
Documented interactions
Last reviewed 13 September 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
Additive serotonergic activity
Severe Does 5-HTP interact with Tramadol with paracetamol?
5-HTP is turned into serotonin in the body, and tramadol with paracetamol (Tramacet) contains tramadol, which raises serotonin as part of how it works, so taking the two together can cause serotonin syndrome (agitation, sweating, tremor, a racing heart, confusion). Do not take 5-HTP with tramadol with paracetamol; if you already take both, tell the prescriber who manages it, and do not stop it on your own.
Evidence: Supported by human study data.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does Rhodiola Rosea interact with Tramadol with paracetamol?
Rhodiola has mild effects on serotonin pathways, and tramadol with paracetamol (Tramacet) contains tramadol, which raises serotonin as part of how it relieves pain. Taking them together may increase the risk of serotonin syndrome. Most people tolerate the combination, but watch for restlessness, sweating, tremor, or a racing heart, and talk to your prescriber before stacking them, especially if your tramadol dose has recently changed.
Evidence: Limited human data, from small studies or case reports.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does St John's Wort interact with Tramadol with paracetamol?
Tramadol with paracetamol (Tramacet) contains tramadol, which raises serotonin as part of how it relieves pain, and St John's Wort raises serotonin too. Taking them together may increase the risk of serotonin syndrome (agitation, sweating, tremor, shivering, a racing heart, confusion). This is not a strict do-not-combine like St John's Wort plus an SSRI, but it is one to avoid stacking without your prescriber's involvement, especially if your tramadol dose has recently gone up.
Evidence: Supported by human study data.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.
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How the checker decides
Every result has a source
Each pair we have assessed is cited to a published study (PMID) or the British National Formulary, so you can read the source yourself.
Four kinds of answer
Severe, caution, no known interaction, and not yet assessed. A pair we have not assessed is never shown as clear.
- Severe
- Caution
- No known interaction
- Not yet assessed
Nothing in our data is not a clearance
When nothing in our data records a problem with a pair, the result says no known interaction at typical doses, which is not a clearance: your pharmacist or GP can check the pair against your full medical history.
A full supplement review, built around you, not a generic stack.
The free checker answers one interaction question at a time. A Distil report reviews the bigger picture: your goals, diet, medications, current supplements and any blood results you provide, then shows what appears worth keeping, changing, adding or leaving out.
- what your diet already covers, so you are not adding a capsule for something food is already handling
- which evidence-graded compounds are worth considering for your goals, and which were considered but left out
- what to keep, change or stop from what you already take, plus the order to introduce anything new
- how your medications and complete supplement stack fit together, with daily timing and a clear point for reassessment
The interaction check is one section of the full report. You also get the reasoning behind each recommendation and the evidence references used.
£49 until 30 June 2027 · £79 from 1 July 2027.
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