I hope this comes out ok.  Here is the info :)  Please let me know if you take it and if you feel it helps :) Thank you :)

How does it work?

This medicine contains two active ingredients, tramadol hydrochloride and paracetamol. These are both pain-relieving medicines.

Tramadol hydrochloride is a type of painkiller called an opioid. It is related to morphine, though is not as strong a painkiller. Opioid painkillers work by mimicking the action of naturally occurring pain-reducing chemicals called endorphins. Endorphins are found in the brain and spinal cord and reduce pain by combining with opioid receptors.

Tramadol mimicks the action of our natural endorphins by combining with the opioid receptors in the brain and spinal cord. This blocks the transmission of pain signals sent by the nerves to the brain. Therefore, even though the cause of the pain may remain, less pain is actually felt.

Tramadol also works by enhancing the activity of neurotransmitters in the brain and spinal cord. Neurotransmitters are chemical compounds that act as chemical messengers between the nerve cells. Tramadol enhances the effect of the neurotransmitters serotonin and noradrenaline, and this action also helps relieve pain.

Paracetamol is a non-opioid painkiller that on its own is used to relieve mild to moderate pain. It can also reduce fever. It is not fully understood how paracetamol works.

The combination of tramadol and paracetamol in this medicine is used to provide relief from moderate to severe pain.

What is it used for?

• Moderate to severe pain
  
  

• This medicine may cause drowsiness. If affected do not drive or operate machinery. Alcohol should be avoided.
  
  
• Alcohol increases the risk of liver damage that can occur if an overdose of paracetamol is taken. The hazards of paracetamol overdose are greater in persistant heavy drinkers and in people with alcoholic liver disease.
  
  
• Do not exceed the recommended dose of this medicine, which will be stated in the product packaging or information leaflet supplied with the medicine.
  
  
• Some people may rarely experience withdrawal symptoms when they stop taking this medicine. These may include feeling agitated, anxious, nervous or shaky, or having difficulty sleeping. Tell your doctor if you experience any of these symptoms after stopping this medicine. These effects usually disappear after a few days.
  
  
• This medicine is not recommended for children under 12 years of age.
  
  
• An overdose of paracetamol is dangerous and capable of causing serious damage to the liver and kidneys. You should never exceed the dose stated in the information leaflet supplied with the medicine. Immediate medical advice should be sought in the event of an overdose with this medicine, even if you feel well, because of the risk of delayed, serious liver damage.
  
  
• This medicine is not recommended for people with severely decreased kidney function.
  
  

• Decreased kidney function
  
  
• Diseases of the bile ducts
  
  
• Head injury
  
  
• History of drug, alcohol or medication dependence or abuse
  
  
• History of fits (seizures), eg epilepsy
  
  
• Impaired breathing ability
  
  
• Impaired conciousness
  
  
• Increased pressure in the brain (raised intracranial pressure)
  
  
• Moderately decreased liver function
  
  
• People over the age of 75 years
  
  
• Reduced blood flow to vital internal organs (shock)
  
  

• Breastfeeding
  
  
• People under the influence of (intoxicated with) alcohol, sleeping tablets, tranquilizers, psychotropic drugs (those affecting mood or emotions) or other painkillers that act on the brain, eg morphine, codeine
  
  
• People who have taken monoamine-oxidase inhibitor antidepressants (MAOIs) in the last 14 days
  
  
• Pregnancy
  
  
• Severely decreased liver function
  
  
• Uncontrolled epilepsy
  
  

• The safety of this medicine during pregnancy has not been established, therefore it should not be used by pregnant women. Consult your doctor.
  
  
• This medicine passes into breast milk. Women who are breastfeeding should not use this medicine. Seek medical advice from your doctor.
  
  

• Do not take more than 2 at any one time. Do not take more than 8 in 24 hours.
  
  
• Do not take this medication with any other products containing paracetamol.
  
  
• This medication is to be swallowed whole, not chewed.
  
  
• This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.
  
  

• Headache
  
  
• Dry mouth
  
  
• Changes in mood
  
  
• Confusion
  
  
• Sweating
  
  
• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
  
  
• Abnormal heart beats (arrhythmias)
  
  
• Seizures (convulsions)
  
  
• False perceptions of things that are not really there (hallucinations)
  
  
• Pins and needles (paraesthesia)
  
  
• Awareness of your heartbeat (palpitations)
  
  
• Dizziness
  
  
• Difficulty in breathing (dyspnoea)
  
  
• Sleepiness (somnolence)
  
  
• Difficulty or pain on passing urine (dysuria)
  
  
• Skin reactions such as rash and itch
  
  
• Anxiety
  
  
• Difficulty or pain when swallowing (dysphagia)
  
  
• Trembling
  
  

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

You should tell your doctor or pharmacist what medicines you are using, particularly those listed below, before you start treatment with this medicine. This includes those bought without a prescription and herbal medicines. Likewise, check with your doctor or pharmacist before starting any new medicines while you are taking this medicine.

The manufacturer states that this medicine should not be taken at the same time as, or within two weeks of, monoamine oxidase inhibitors (MAOIs). These include the following medicines:
- MAOI antidepressants such as phenelzine, tranylcypromine, isocarboxacid,
- the MAO-A inhibitor antidepressant moclobemide
- the MAO-B inhibitor selegiline, used for Parkinson's disease
- the antibiotic linezolid.

There is an increased risk of drowsiness and sedation if this medicine is taken with other medicines that can cause drowsiness, such as the following:
- tricyclic antidepressants, eg amitriptyline
- some antipsychotics
- other opioids, eg codeine, morphine
- benzodiazepines, eg diazepam
- barbiturates, eg phenobarbital
- sedating antihistamines, eg chlorpheniramine
- sleeping tablets.

There may be an increased risk of convulsions or seizures if this medicine is taken with SSRI antidepressants (eg fluoxetine), tricyclic antidepressants (eg amitriptyline), antipsychotics (eg chlorpromazine) or bupropion.

If this medicine is taken with SSRI antidepressants such as fluoxetine, or triptans for migraine such as sumatripitan, there may also be an increased risk of other side effects, as these medicines all enhance the activity of serotonin in the brain.

The manufacturer states that this medicine is not recommended for use in combination with the following medicines: buprenorphine, nalbuphine, pentazocine.

Carbamazepine may decrease the blood level of tramadol, which may make it less effective at relieving pain.

Tramadol and regular or long-term use of paracetamol may enhance the anti-blood-clotting effect of anticoagulant medicines such as warfarin. If you are taking warfarin your blood clotting time (INR) should be monitored when you start and stop treatment with this medicine.

You should avoid taking other medicines that contain paracetamol or tramadol while taking this medicine, as this can easily result in exceeding the maximum recommended daily dose of these medicines. Many cold and flu remedies and over-the-counter painkillers contain paracetamol, so be sure to check the ingredients of any other medicines before taking them with this one.

Cholestyramine may reduce the absorption of paracetamol from the gut.

Metoclopramide and domperidone may increase the absorption of paracetamol from the gut.