Not recommended in severe renal impairment (CrCl <10 mL/min); severe resp impairment. Not to be used in severe hepatic impairment. Not to be used during pregnancy & lactation. Childn <12 yr. Tramadol: Not suitable as a substitute in opioid-dependent patients; cannot suppress morphine w/drawal symptoms. Convulsions in patients susceptible to seizures or taking other medications that lower seizure threshold, especially SSRIs, TCAs, antidepressants, antipsychotics, centrally acting analgesics or local anaesth; increased risk when exceeded the recommended upper dose limit. History of epilepsy. Paracetamol: Patients w/ non-cirrhotic alcoholic liver disease. Alcohol dependence.
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